剖宫产手术麻醉前用缩合葡萄糖液预扩容效果及安全性的临床观察

目的观察腰硬联合麻下剖宫产手术病人使用缩合葡萄糖氯化钠注射液预扩容的效果和安全性。方法把50例一般情况良好，即将进行剖宫产术的产妇随机分为缩合葡萄糖氯化钠注射液组（PG组）和复方乳酸钠组（RL组），各25例，于麻醉前按15ml／（kg·h）的速度分别输入缩合葡萄糖氯化钠注射液和复方乳酸钠注射液15ml／kg，并记录分析预扩容前（开放补液后）、预扩容后（麻醉前）、麻醉后5min、10min、15min、20min平均动脉压（MAP）、心率（HR）变化，预扩容前、预扩容后Hct、pH、Glu、APTT、PT的变化，麻醉后使用麻黄素的病例、术后低血压病例及输液不良反应，麻醉时间和手术时间等。结果麻醉后RL组MAP、HR变化的幅度与其麻醉前及PG组相比均具有显著性差异（P〈0．01），扩容后PG组的Hct、pH、Glu、APTT、PT变化明显（P〈0．05或P〈0．01），但仍在正常范围内；麻醉后PG组低血压5例，RL组12例；术后发生低血压在PG组7例，RL组4例；全部病例均无发生过敏等不良反应。结论剖宫产术病人使用缩合葡萄糖氯化钠注射液预扩容，能有效抵制腰-硬联合麻醉所产生的心血管变化，适量使用不会明显影响血液凝固和提升血糖。

Clinical observation of effective and security of pre-anesthetic hypervolemic hemodilution with polyglucose before cesarean section

Objective To observe the effects and security of pre-anesthetic hypervolemic hemodilution with polyglucose sodium chloride on patients under cesarean section combined with spinal-epidural anesthesia. Methods 50 patients were randomly divided into two groups. 25 cases were injected with polyglucose sodium chloride as polyglucose sodium chloride injection (PG) group and 25 cases were injected with compound sodium lactate as compound sodium lactate(RL) group. The changes of mean arterial pressure, (MAP), heart rate (HR), Hct, pH, Glu, APTT and PT before and after pre-anesthetic hypervolemic hemodilution, 5 min, 10min, 15min and 20min after anesthesia were registered.The cases which were injected ephedrine after anesthesia or with low postoperative blood pressure, infusion adverse reactions, anesthesia time and surgical time were also recorded and analyzed. Results The MAP and HR in RL group after anesthesia were significantly different from that before, anesthesia and that in PC, group (P<0.01). After pre-anesthetic hypervolemic hemodilution, the Hct, pH, Glu, APTT, PT changed significantly (P<0.05 or 0.01), but still within normal range. After anesthesia, there were 5 cases with low blood pressure in PG group and 12 cases in RL group. After operation, there were 7 cases with low blood pressure in PG group and 4 cases in RL group. All the cases did not have adverse reactions. Conclusion The pre-anesthetic hypervolemic hemodilution with polyglucose sodium chloride on patients undertaking cesarean section can effectively resist the cardiovascular changes produced by combined spinal-epidural anesthesia. Appropriate use will not significantly affect the blood coagulation or blood sugar.