胶体或晶体预扩容对联合腰麻下剖宫产母体和胎儿的影响

【目的】研究使用胶体或晶体预扩容对联合腰麻下剖宫产母体循环和胎儿的影响。【方法】择期单胎足月剖宫产产妇60例，ASAⅠ～Ⅱ级，在b～4行腰硬联合麻醉，随机分为晶体组（R组29例）和胶体组（H组31例）。麻醉操作时分剐给予林格液（R组）、6％羟乙基淀粉130／0．4（H组）各500mL预扩容，在20min内输注完成。监测产妇麻醉前（T1）、给药后（T2）、胎儿娩出时（T3）的血压、心率变化，胎儿娩出后行Apgar平分，并抽取胎儿脐动脉血行血气分析。【结果】两组产妇血压在T2时与T1比较降低有统计学意义；与R组相比，H组血压T2时增高有统计学意义；心率变化在组内和组间比较差异均无显著性。胎儿娩出后，Apgar评分及脐动脉血气分析两组差异无显著性。【结论】在联合腰麻下，虽然产妇使用胶体预扩容时循环系统比晶体预扩容稳定，但从胎儿的Apgar评分及脐动脉血气分析结果上看，胶体预扩容并无明显的优势。

Effects of Crystalloid or Colloid Preload on Parturient and Fetus Undergoing Combined Spinal Anesthesia for Cesarean Section

[Objective] To investigate the effects of crystalloid and colloid preload on maternal circulation and fetus undergoing combined spinal anesthesia for cesarean section. [Methods] Sixty parturients with ASA Ⅰ～Ⅱ grade, scheduled for elective cesarean section during combined spinal anesthesia were allocated randomly into crystaltoid group（group R, n =29） and colloid group（group H, n = 31）. Group R received 500mL Ringer＇s solution and group H received 500mL 6% hydroxyethyl starch 130/0.4. Fluid preload was completed within 20 minutes. Maternal blood pressure and heart rate were monitored before the preload（ T1）, after anesthesia （T2） and when the baby is delivered （T3）. Fetal Apgar score was assessed and fetal umbilical arterial blood was drawn for blood gas analysis after the baby was delivered. [Results]Compared with T~, maternal blood pressure in the two groups was significantly reduced in T2. As compared with the group R, the blood pressure in T2 was statistically significant higher in group H. Heart rate changes in the groups and between the two groups had no statistical significance. After the baby was delivered, there were no significant differL ences in Apgar scores and umbilical arterial blood gas analysis between the two groups. [Conclusion] Undergoing spinal anesthesia, the maternal circulatory system when preload with colloidal is more stable than that with crystalloid, but on account of the results of fetal, preload with colloidal has no obvious advantage.