预充佳乐施对剖宫产产妇血流动力学和胎儿血气的影响  

EFFECT OF PRE-PERFUSING GELOFUSINE ON MATERNAL HEMODYNAMICS AND FOETAL BLOOD GAS IN UTERINE-INCISION DELIVERY

作　　者：徐洪刚[1] 王昊[1] 郑宇[1] 

机构地区：[1]辽宁医学院附属第一医院麻醉科,锦州121001

出　　处：《现代预防医学》2010年第2期251-253,共3页Modern Preventive Medicine

摘　　要：[目的]观察剖宫产围术期预充佳乐施对母体血流动力学和胎儿血气的影响,评价其应用的可行性和安全性。[方法]50例择期剖宫产妇,ASAⅠ～Ⅱ级,随机双盲分为两组:L组为林格液组;G组为佳乐施组,每组25例。监测并记录入室时(T0)、腰麻前(T1)、麻醉后3min(T2)、胎儿娩出时(T3)、术毕(T4)的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2);采脐动、静脉血和母体动脉血测定血乳酸盐、红细胞比积(Hct)和血气,同时记录新生儿生后1min和5min的Apgar评分并计算胎儿氧摄取率(O2ER)。[结果]与T0相比,T2、T3、T4时点L组产妇SBP、DBP明显下降,HR明显增快(P﹤0.05),G组在T2、T3、T4时SBP、DBP虽有降低,但与T0相比较差异无统计学意义(P﹥0.05)。在T2、T3、T4时点L组与G组对应的时间点比较SBP、DBP明显降低,HR明显增加(P﹤0.05);母动脉血PO2G组明显高于L组,Hct和LacG组明显低于L组;脐动、静脉的PO2G组明显高于L组;G组的胎儿氧摄取率较L组明显升高(P﹤0.05),而两组新生儿1min、5min的Apgar评分无明显差异。[结论]剖宫产围术期,应用佳乐施扩容,能稳定母体的血流动力学,提高胎儿对O2的摄取率,更好地维持母婴内环境稳定,从而进一步提高剖宫产产妇和胎儿的安全性。[Objective] To observe the effect of pre-perfusing Gelofusine in perioperation on maternal hemodynamics and foetal blood gas during the uterine incision delivery and evaluate its feasibility and safety.[Methods] Fifty parturient for selective uterine-incision delivery with ASAⅠ-Ⅱ were randomized into two groups in the double blind study.Patients in group L（n=25） were administered with Ringer Locke liquor,while patients in group G（n=25） with pre-perfusing Gelofusine.Heart rate（HR）,mean arterial pressure（MAP）,SpO2 of the pregnant women in time of T0,T2,T3 and T4 were monitored and recorded.Blood sample from umbilical artery,umbilical vein and maternal artery were collected to measure lactate,Hct and blood gas.Apgar score 1min and 5min after delivery were recorded,and O2ER were calculated.[Results] Compared with the time of T0,SBP and DBP of parturient in group L were decreased significantly in the time of T2,T3 and T4（P﹤0.05）.Although SBP and DBP decrease at T2,T3 and T4 were also observed in group G,there was no significant difference compared with T0.The BP was significant lower and HR was significantly higher in group L than that of group G at T2,T3 and T4（P﹤0.05）.The maternal PO2 and VO2 in group G was significantly higher than of group L,while the Hct and Lactate were significantly lower than group.The PO2 of umbilical artery and vain was higher in group L.O2ER was significantly elevated in group G compare with group L（P﹤0.05）.There was no difference of 1min and 5min Apgar score between the two groups.[Conclusion] Application of pre-perfusing Gelofusine in perioperation is helpful to stabilize maternal hemodynamics and elevate the O2 uptake by foetus.This may be beneficial to the safety of parturient and foetus in uterine-incision delivery.

关 键 词：佳乐施 剖宫产 血气 血流动力学 

分 类 号：R719.8[医药卫生—妇产科学]