羟乙基淀粉130/0.4氯化钠注射液用于剖宫产术蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉前预填充的有效剂量  

Preloading dose of hydroxyethyl starch sodium chloride(130/0.4) before combined spinal and epidural anesthesia for caesarean section

作　　者：李胜华[1] 吴娟[1] 罗威[1] 王长社[1] 陆勤[2] 

机构地区：[1]上海市嘉定区妇幼保健院麻醉科,201800 [2]上海市嘉定区妇幼保健院产科,201800

出　　处：《上海医学》2012年第10期848-851,共4页Shanghai Medical Journal

基　　金：上海市嘉定区卫生局科研基金资助项目(KYXM-2007-11-03)

摘　　要：目的探讨蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉前静脉滴注羟乙基淀粉130/0.4氯化钠注射液预防行剖宫产术的产妇术中低血压的有效剂量。方法选择美国麻醉医师学会分级Ⅰ或Ⅱ级、孕38～40周、第1胎、择期行剖宫产术的产妇160例,随机分为4组,每组40例。平衡液组在麻醉前静脉滴注5mL/kg乳酸钠林格注射液,羟乙基淀粉低、中、高剂量组分别静脉滴注5、10、15mL/kg羟乙基淀粉130/0.4氯化钠注射液。静脉输液结束后,在L3与L4间隙穿刺行蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉。观察产妇入手术室(T1),静脉滴注液体完即刻(T2),鞘内注射药物5min(T3)、10min(T4)、20min(T5)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)及新生儿出生后1和5min的Apgar评分。采集T1和T2时间点,产妇的动脉血及胎儿取出时的脐动脉血行血气分析。结果平衡液组和羟乙基淀粉低剂量组T3、T4、T5时间点的MAP均显著低于同组T1时间点(P值分别<0.05、0.01),羟乙基淀粉中、高剂量组组内各时间点间MAP的差异均无统计学意义(P值均>0.05),羟乙基淀粉中剂量组T4、T5时间点及羟乙基淀粉高剂量组T3、T4、T5时间点的MAP均显著高于平衡液组同时间点(P值分别<0.05、0.01)。4组组内和组间SpO2的差异均无统计学意义(P值均>0.05)。4组间产妇动脉血和胎儿取出时脐动血的pH值、动脉血氧分压、动脉血二氧化碳分压的差异均无统计学意义(P值均>005)。平衡液组产妇的麻黄素使用率为30%,显著高于羟乙基淀粉低剂量组的10%(P<0.05),羟乙基淀粉中、高剂量组产妇均无未使用麻黄素。4组间新生儿出生后1、5min的Apgar评分的差异均无统计学意义(P值均>0.05)。结论择期行剖宫产术的产妇在蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉前静脉滴注羟乙基淀粉130/0.4氯化钠注射液预防术中低血压的有效剂量为10mL/kg。Objective To explore the preloading dose of hydroxyethyl starch sodium chloride 130/0.4（Voluven） before combined spinal and epidural anesthesia（CSEA） in order to prevent hypotension during caesarean section.Methods A total of 160 primiparas,American Society of Anesthesiologist（ASA） Ⅰ and Ⅱ,38 to 40 weeks of pregnancy,scheduled for cesarean delivery were randomized into 4 groups（n=40）.Group A：preloading 5 mL/kg sodium lactate ringer＇s injection,group B：preloading 5 mL/kg Vouluven,group C：preloading 10 mL/kg Vouluven,and group D：preloading 15 mL/kg Vouluven.After preloading infusion,CSEA was performed in the intervertebral space of L3—L4.Mean arterial pressure（MAP）,heart rate（HR）,and saturation of pulse blood oxygen（SpO2） were measured before preloading infusion（T1）,after preloading infusion（T2）,and at 5 mins（T3）,10 mins（T4） and 20 mins（T5） after intrathecal injection of anesthetic.Apgar scores were recorded at 1 min and 5 mins after neonatal delivery.Maternal arterial blood samples were collected before and immediately after preloading infusion,while umbilical artery blood samples were collected immediately after fetus delivery to perform blood gas analysis.Results MAP at T3,T4 and T5 were significantly lower than that at T1 in group A and group B（P0.05 or P0.01）.There was no significant difference in MAP between group C and group D（all P0.05）.MAP at T4,T5 in group C and at T3,T4 and T5 in group D were significantly higher than those in group A（P0.05 or P0.01）.There were no significant differences in SpO2,pH,pressure of arterial oxygen,pressure of arterial carbon dioxide and Apgar scores among the 4 groups（all P0.05）.The use of ephedrine in group A was significantly more frequent than that in group B（30% vs.10%,P0.05）.Ephedrine was not applied in group C and D.Conclusion 10 mL/kg Voluven can effectively prevent hypotention induced by CSEA in elective caesarean section.（Shanghai Med J,2012,35：848-851）

关 键 词：乙基淀粉130 0 4氯化钠注射液 预填充 蛛网膜下腔阻滞联合硬脊膜外腔阻滞 剖宫产 

分 类 号：R614[医药卫生—麻醉学]