腰-硬联合麻醉剖宫产容量治疗对母婴的影响  

The impact of fluid management on combined spinal-epidural anesthesia for cesarean section in parturients and neonates

作　　者：徐世琴[1] 彭宇竹[1] 沈晓凤[2] 沈洁[2] 汪福洲 吴海波 

机构地区：[1]南京医科大学公共卫生学院,210029 [2]南京医科大学附属南京妇幼保健院麻醉科

出　　处：《临床麻醉学杂志》2013年第7期675-677,共3页Journal of Clinical Anesthesiology

基　　金：南京医科大学科技发展基金重点项目(09NJMUZ39)

摘　　要：目的探讨不同容量治疗方式对腰-硬联合麻醉(combined spinal-epidural anesthesia,CSEA)剖宫产术母婴的影响。方法足月健康择期行剖宫产产妇120例,随机均分为三组。晶体组和胶体组手术前15min分别输入复方乳酸钠13ml/kg和羟乙基淀粉130/0.4氯化钠注射液10ml/kg,对照组不作处理。三组术中均持续输入复方乳酸钠10ml/min至术毕。三组均于蛛网膜下腔注入0.5%布比卡因8～10mg。记录产妇术中低血压发生情况,检测和记录产妇容量治疗前(T1)、手术开始时(T2)、胎儿取出即刻(T3)和手术结束时(T4)的凝血酶原时间(PT)、激活部分凝血酶原时间(APTT)、Plt、Hct及动脉血气值以及新生儿PT、APTT、Plt、Hct、脐静脉血气值、出生后1、5minApgar评分及神经行为学评分。结果晶体组和胶体组低血压发生率分别为8例(20%)和3例(7.5%),明显低于对照组的18例(45%)(P<0.05)。T2～T4时胶体组容量治疗后Hct明显低于对照组和T1时(P<0.05)。三组新生儿凝血功能、Hct、脐静脉血气值、出生后1、5min Apgar评分及神经行为学评分差异均无统计学意义。结论术前15min输入复方乳酸钠13ml/kg或羟乙基淀粉130/0.4氯化钠注射液10ml/kg行容量治疗,均能降低CSEA剖宫产术中产妇低血压发生率,对产妇凝血功能及酸碱平衡无明显影响,对新生儿无明显影响。Objective To evaluate the impact of different fluid management methods on combined spinal-epidural anesthesia for cesarean section in parturients and neonates. Methods One twenty healthy full-term parturients secheduled for elective cesarean section were randomly divided into three groups. Crystalloid group received intravenous 13 ml/kg crystaltoid 15 min before operation. Colloid group received intravenous 10 ml/kg colloid 15 min before operation. Three groups received intravenous 10 ml/min crystalloid during the operation. All parturients were injected 8-10 mg of 0.5% bupivacaine in the subarachnoid space. The vital signs of parturients were recorded. PT, APTT, Ph, Hct and arterial blood gas analysis were all measured at baseline （T1） and in following times include operation onset（T2）, fetus taken out of surgery （T3）, and at the end of surgery（T4 ）. Neonatal PT, APTT, Plt, Hct, umbilical venous blood gas analysis, at 1,5 min after birth Apgar scores, and the assessment of infants＇ behavior were recorded. Ephedrine consumption were calculated. Results The incidence of hypotension in crystalloid group, colloid group, and control group were 8 （20%）, 3 （ 7.5%）, and 18 （45%）, respectively. Compared with control group the incidence of hypotension in crystalloid group and colloid groups was lower （P〈0. 05）. At T2-T4 ephedrine consumption in colloid group was less than that in control group and at T1 （P〈0.05）. Compared with control group Hct at any one point after fluid management were significantly decreased in colloid group （P〈0.05）. There was no significant difference in neonatal PT, APTT, Plt, Hct, blood gas values, Apgar scores at 1,5 min after birth, and the assessment of infantsr behavior. Conclusion The parturients who receive intravenous 10 ml/kg colloid or 13 ml/kg crystalloid 15 minutes before operation have lower incidence of hypotension during cesarean section with combined spinal-epidural anesthesia. Fluid management with the colloid can reduce Hot, and impr

关 键 词：剖宫产 腰-硬联合麻醉 容量治疗 低血压 凝血功能 

分 类 号：R614[医药卫生—麻醉学]