腰麻剖宫产不同左倾位下腔静脉内径变化及与低血压的关系  

Observations on correlation between inferior vena cava diameter and hypotension following spinal anesthesia during cesarean section with ultrasonography

作　　者：郭然[1,2] 薛勤[3] 胡永明[2] 李峰[2] 谭洁[4] 朱玉莲[4] 金文杰[1] 钱燕宁[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科,南京市210029 [2]江阴市人民医院麻醉科 [3]江阴市人民医院超声科 [4]江阴市人民医院妇产科

出　　处：《临床麻醉学杂志》2013年第8期771-773,共3页Journal of Clinical Anesthesiology

摘　　要：目的采用超声观察腰麻后拟行剖宫产产妇不同左倾位时下腔静脉内径的变化,并探讨其与低血压的关系。方法足月妊娠行择期剖宫产产妇80例,随机分为两组,每组40例。0.5%布比卡因7.5mg腰麻后产妇平卧,右腰臀部放置斜面为15°的体位垫(L组)或将手术床左倾斜15°(T组)。记录产妇低血压(SBP<80%基础值)的发生率,并用超声观察下腔静脉内径的变化。结果 L组产妇下腔静脉内径明显大于T组[(1.48±0.16)cmvs.(1.40±0.15)cm,P<0.05],低血压发生率(37.5%vs.61.5%)明显低于T组(P<0.05)。产妇去氧肾上腺素用量与下腔静脉内径呈等级负相关(r=-0.529,P<0.01)。产妇低血压发生次数与下腔静脉内径呈等级负相关(r=-0.458,P<0.01)。结论腰臀部左倾位比手术床左倾位能更有效降低腰麻后剖宫产产妇低血压的发生率,其机制与改善下腔静脉内径有关。Objective To observe two different left lateral tilt positions on interior vena cava diameter （IVCD） and frequency o{ hypotension following spinal anesthesia during cesarean section with ultrasonography, and to explore the correlation between them. Methods Eighty in-term parturients with singleton scheduled for selective cesarean section under spinal anesthesia were randomly divided into two groups with 40 cases each. After the completion of subarachnoid injection, parturients were placed with either a wedge under the right crista iliaca region （group L, lumbar tilt） or 15~ left table tilt （group T, table tilt）. Blood pressure was monitored every minute for 10 minutes from the subarachnoid injection and at the time point of skin incision and delivery. IVCD was recorded at 3 min after the subarachnoid injection with ultrasonography. Hypotension, defined as SBPG80% of the baseline, was treated with intravenous phenylephrine 100 txg. The incidence of hypotension, nausea , phenylephrine use and neonatal Apgar scores were recorded. Results IVCD in group L was obviously larger than group T[（1.48＋0.16）cm vs. （1.40~0. 15）cm,P G0.05]. The frequency of hypotension in group T were significantly higher than those in group L （37.5~ vs. 61.5~, P G 0. 05）. IVCD was negatively correlated with hypotension , and IVCD was also negatively correlated with the does of phenylephrine （P G0.05）. Conclusion A lumbar wedge is more effective than left table tilt in improving IVCD for cesarean delivery following spinal anesthesia, that is one of the mechanisms of preventing hypotension following spinal anesthesia.

关 键 词：剖宫产 腰麻 下腔静脉内径 左倾位 超声 

分 类 号：R614[医药卫生—麻醉学]