胶体液和晶体液容量预负荷对硬膜外麻醉下剖宫产患者血流动力学及新生儿的影响  

The effects of colloid and crystalloid solution for volume preloading on maternal hemodynamics and neonatal outcome in epidural anesthesia for cesarean section

作　　者：刘富兵[1] 刘洋[2] 秦榜勇[1] 

机构地区：[1]遵义医学院附属医院麻醉科,563003 [2]遵义医学院附属医院急诊科,563003

出　　处：《贵州医药》2010年第9期791-793,共3页Guizhou Medical Journal

摘　　要：目的本研究拟观察胶体液及晶体液预负荷对剖宫产患者及新生儿的影响。方法征得病人同意并签字后,健康足月妊娠择期剖宫产妇80例随机分为A、B两组(n=40)。A、B组分别为硬膜外麻醉前20min内乳酸林格液或琥珀酰明胶500mL预负荷,记录产妇麻醉前和麻醉后收缩压、舒张压、心率、术中恶心呕吐情况,新生儿Apgars评分、新生儿脐静脉血pH、PvO2、SvO2、CvO2及脐动脉血pH、P(O2)、SaO2、CaO2。结果 A组患者麻醉后SBP和DBP明显较麻醉前下降(P<0.01),B组麻醉后SBP和DBP较麻醉前差异无显著意义(P>0.05),A、B两组患者在麻醉前及麻醉后心率及恶心呕吐频率差异无显著意义(P>0.05)。B组新生儿脐静脉血pH、PvO2、SvO2、CvO2、脐动脉血P(O2)显著高于A组(P值分别为<0.01、<0.01、<0.05、<0.01、<0.05)。A、B两组新生儿Ap-gar评分差异无显著意义(P>0.05)。结论琥珀酰明胶预负荷不仅能够稳定硬膜外麻醉下剖宫产患者的血流动力学稳定性,还能有效地改善胎儿体内代谢状况,提高胎儿对麻醉及手术期缺氧的耐受。Objective The role of crystalloid or colloid preloading to prevent hypotension associated with epidural anesthesia in parturients during cesarean section.This study was to investigate the effects of volume preload with either crystalloid or colloid on changes of maternal hemodynamics and neonatal outcomes.Methods After written informed consent had been obtained from each patient,80 healthy parturients undergoing cesarean section were divided into two groups randomly and there were 40 patients for each group.A group received 500ml Ringer＇s solution in twenty minutes before anesthetized and B group received 500ml gelofusine.Systolic blood pressure （SBP）,Diastolic blood pressure （DBP）,heart rate （HR）,nausea and vomitting were recorded before and after anesthetized.Neonatal outcome was also assessed measuring pH,PvO2、SvO2、CvO2 and pH、PaO2、SaO2、CaO2 in umbilical venous and arterial blood samples,respectively.Apgar score was also measured after delivery.Results There was no difference in SBP and DBP among the B group after epidural anesthesia,However,a significant decline in SBP and DBP were observed in A group （P 0.01）.There was no significant different in HR between before and after epidural anesthesia but nausea and vomitting was less frequent in B group.Compared A group,pH,PvO2、SvO2、CvO2 in umbilical venous blood samples and PaO2 in umbilical arterial blood samples were significantly higher in B group （P0.01,0.01,0.05,0.01,0.05,respectively.） There was no difference in Apgar score among the two groups.Conclusion Gelofusine preload not only improved maternal haemodynamic stability during epidural anaesthesia for caesarean section,but improved neonatal energy metabolism and enhanced them tolerance for anesthesia and hypoxia during operation.

关 键 词：硬膜外麻醉 剖宫产 胶体液 晶体液 血流动力学 胎儿 

分 类 号：R614[医药卫生—麻醉学] R719.8[医药卫生—外科学]