胶体预冲量对剖宫产脐血S100β蛋白及胎盘体视学的影响(英文)  

Effects of colloid preload on placenta stereology and cord blood S100β protein during cesarean section under spinal anesthesia

作　　者：彭雪梅[1] 刘慧慧[2] 席露[3] 王华东[4] 李瑞满[5] 帅兵 

机构地区：[1]暨南大学附属第一医院麻醉科,广东广州510630 [2]广州中医药大学第一附属医院麻醉科,广东广州510405 [3]广州医学院第三附属医院麻醉科,广东广州510150 [4]暨南大学医学院病理生理教研室,广东广州510630 [5]暨南大学附属第一医院妇产科,广东广州510630 [6]番禺何贤医院麻醉科,广东广州511400

出　　处：《南方医科大学学报》2013年第2期161-165,共5页Journal of Southern Medical University

基　　金：Supported by Natural Science Foundation of Guangdong Province(s2011010004123)~~

摘　　要：目的通过比较不同预充量佳乐施对脐带血血气、脐带血血清S100β浓度及胎盘体视学的影响,观察佳乐施对剖宫产产妇脊椎麻醉低血压的防治效果并探索对母体和胎儿均有利的预充量。方法将45例择期行剖宫产术的单胎足月初产妇随机分为Ⅰ、Ⅱ、Ⅲ组(n=15),麻醉前分别以5、10、15 ml.kg-.1h-1的速度预充佳乐斯10 min,之后开始麻醉手术并以此补液速度持续至胎儿娩出。监测并记录麻醉前(T0)、麻醉后1 min(T1)、2 min(T2)、3 min(T3)、5 min(T4)、10 min(T5)、胎儿娩出时(T6)及术毕(T7)时血压、心率的变化。比较3组新生儿1 min及5 min的Apgar评分,脐带血血气变化及脐带血血清S100β浓度。观察胎盘石蜡切片并用体视学方法分析出胎盘绒毛微血管长度密度和体积密度的变化。结果 3组产妇心率、收缩压比较差异皆无统计学意义(P>0.05),组内各时点差异有统计学意义(P<0.05);Ⅱ、Ⅲ组较Ⅰ组母体血流动力学更稳定。3组脐动脉血血气、新生儿Apgar评分及脐带血血清S100β浓度比较无统计学意义(P>0.05),胎盘绒毛微血管长度密度和体积密度也没有统计学差异(P>0.05)。结论Ⅱ、Ⅲ组预充量较Ⅰ组对低血压有更好的缓冲作用,但考虑到产妇心脏负荷较重,推荐以10 ml.kg-1.h-1的速度从术前10 min开始扩容至胎儿娩出,对母婴更安全有利。Objective To determine the optimal dose of colloid preload, which is both safe and effective, for preventing hypotension in parturients undergoing cesarean section under spinal anesthesia. Methods Forty-five healthy, termed parturients scheduled for cesarean delivery under spinal anesthesia were randomly assigned to 3 colloid preload groups to receive gelofusine infusion at the rates of 5, 10, or15 ml.kg^-1h^-1（groups L IL and Ⅲ, respectively）. Colloid preload was administered 10 min before spinal anesthesia and maintained until the delivery. Blood pressure （BP） and heart rate （HR） of the parturients were monitored during the operation, and Apgar scores at 1 and 5 min after birth were recorded. S100β protein concentration and blood gas values of the umbilical artery were also measured. The vascular adaptation in the placental villous capillary was evaluated stereologically. Results At each time point of measurement, BP and HR showed no significant differences among the 3 groups during the operation （P〉0.05）, but within the same group, BP and HR underwent significant variations during the operation; groups Ⅱ and Ⅲ maintained more stable hemodynamics compared to group I. Apgar scores and blood gas analysis, pH value, and S100β protein in the umbilical artery showed no significant differences among the 3 groups （P〉0.05）. The 3 groups exhibited no significant differences in the length and volume density of the placental villous capillaries （P〉0.05）. Conclusion Colloid preload with gelofusine administered at the rate of 10ml.kg^-1h^-1 can reduce the incidence and severity of hypotension in cesarean section under spinal anesthesia with the least adverse maternal and fetal effects.

关 键 词：剖宫产 腰椎麻醉 低血压 体视学 血清S100β 容量预充 

分 类 号：R614[医药卫生—麻醉学]