高渗氯化钠羟乙基淀粉40对产妇腰麻后低血压及新生儿早期安全的影响  

Influence of Hypertonic Sodium Chloride Hydroxyethyl Starch 40 on Hypotension Induced by Spinal Anesthesia for Cesarean Delivery and on Neonate

作　　者：陈洁琳[1] 周舸[1] 林琳[1] 张莉莉[1] 孙文琴[1] 刘明姬[1] 莫利求[1] 

机构地区：[1]中山大学附属第一医院黄埔院区麻醉手术科,广东广州510700

出　　处：《中山大学学报（医学科学版）》2012年第4期528-531,共4页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：2009年吴孟超医学科技基金(RG-D 2009060)

摘　　要：【目的】探讨预注高渗氯化钠羟乙基淀粉注射液40(HSH40)对腰麻后产妇低血压及新生儿的影响。【方法】60例拟行择期剖宫产的足月产妇,ASA I-II级,随机分为HSH40组(n=30)和乳酸钠林格氏液(RL)组(n=30)。在腰麻前15～20 min内,HSH40组静脉注射250 mL HSH40,RL组静脉注射500 mL RL。腰麻穿刺点在腰3/4椎间隙,注入的腰麻药为0.5%布比卡因2 mL。观察腰麻后15 min内低血压的发生情况,并对新生儿进行Apgar评分,及采集脐带血进行血气分析。【结果】两组患者一般情况差异无统计学意义(P>0.05)。在给予腰麻药后15 min内,RL组与HSH40组的收缩压(SBP)<100 mmHg(1 mmHg=0.133 kPa),<90 mmHg,和<80 mmHg的发生率分别为80.0%vs 40.0%,63.3%vs 10.0%和40.0%vs6.7%,差异均具有统计学意义(P<0.01)。两组新生儿1 min和5 min的Apgar评分及脐带动静脉血血气分析结果差别无统计学意义(P>0.05)。HSH40组的脐带血的钠浓度高于RL组(P<0.01)。【结论】预注HSH40不能完全避免腰麻引起的产妇严重低血压,不能改变新生儿的早期预后,且提高了脐带血的钠离子浓度,剖宫产术中使用应慎重。[ Objective ] To evaluate the influence of hypertonic sodium chloride hydroxyethyl starch 40 （HSH40） on hypotension induced by spinal anesthesia for cesarean delivery and on neonate. [ Methods ] Sixty termed parturients （ASA I-II） scheduled for cesarean section were randomly divided into Group HSH40 （n = 30） and Group RL （n = 30）. HSH40 250 mL and Ringer lactate solution 500 mL were infused in 15 to 20 min before intrathecal administration of local anesthetics in Group HSH40 and Group RL, respectively. Spinal anesthesia was performed at lumber 3/4 interspaces with 0.5 % bupivoeaine 2 mL. Incidence of severe hypotension （Systolic blood pressure 〈100 mmHg, 1 mmHg -= 0.133 kP ） was recorded in 15 min after induction of spinal anesthesia. The Apgar scores at 1 and 5 minutes were evaluated and the umbilical blood samples were collected for blood gas analysis. [ Results ] Patient characteristics were comparable between the two groups （P 〉 0.05）. In 15 min after intratheeal administration of local anesthetics, the incidence of hypotension （Systolic blood pressure ）〈 100 mmHg, 〈 90 mmHg and 〈 80 mmHg in Group RL and Group HSH40 were 80.0 % vs 40.0 %, 63.3 % vs 10.0 %, and 40.0 % vs 6.7 %, respectively ,（P 〈 0.01 ）. No difference in blood gas analysis of umbilical blood samples was found （P 〉 0.05 ）. The sodium concentration of umbilical blood samples was higher in Group HSH40 than in Group RL （P 〈 0.01）. [Conclusion] HSH40 preloading can not eliminate severe hypotension induced by spinal anesthesia for cesarean section, can not improve the early outcome of the neonates, but increased sodium concentration in umbilical cord, it should be prudent to use cesarean delivery.

关 键 词：高渗羟乙基淀粉注射液40 剖宫产术 腰麻 腰硬联合麻醉 低血压 脐带血血气分析 APGAR评分 

分 类 号：R614[医药卫生—麻醉学]