腰硬联合麻醉下剖宫产术中左侧斜卧位对产妇血流动力学的影响  

Effect of left tilt 15-degree position on the hemodynamic changes during cesarean section under combined spinal-epidural anesthesia

作　　者：陈志强[1] 雷洪伊[1] 叶小平[1] 梁启波[1] 张鸿飞[1] 徐世元[1] 

机构地区：[1]南方医科大学珠江医院麻醉科,广州510280

出　　处：《广东医学》2016年第1期34-36,共3页Guangdong Medical Journal

摘　　要：目的 观察腰硬联合麻醉下剖宫产术中体位变化对产妇血流动力学的影响。方法 将40例ASAⅠ-Ⅱ级拟行剖宫产术的产妇分为A、B两组,每组20例,于剖宫产术中分别采用平卧位和左侧斜卧15°位。分别于入室后5min、腰硬联合麻醉时侧卧位后3min、麻醉后3min、切皮即刻、胎儿娩出后3min、手术结束时点记录产妇心输出量、每搏量、心率、平均动脉压、总外周阻力、胸腔液体含量。结果 两组产妇总输液量、升压药用量、心率、胸腔液体含量无明显差异;心输出量、每搏量组内各时比较点差异有统计学意义（P〈0.05）,但组间比较差异无统计学意义（P〉0.05）;麻醉后A组血压、总外周阻力下降较B组明显（P〈0.05）。结论 腰硬联合麻醉剖宫产术围术期血流动力学波动较大,主要发生在麻醉后及胎儿娩出前后,需要及时准确的监测以指导治疗。术中采取左侧斜卧位,配合恰当的容量治疗及麻醉管理,可减少低血压的发生。Objective To investigate the effect of left tilt 15 -degree position on hemodynamie changes with the non - invasive hemodynamie monitor （ NICOM ） during cesarean section under combined spinal - epidural anesthesia. Methods 40 ASAⅠ-Ⅱ puerperas undergoing cesarean section under combined spinal - epidural anesthesia were en- rolled and divided into supine group and left tilt 15 -degree group randomly. Hemodynamic parameters including cardiac output, stroke volume, mean arterial pressure, heart rate, total peripheral vascular resistance, and thoracic fluid content were recorded at 6 time points by NICOM system： baseline, 3 min after lateral position, 3 min after spinal anesthesia, skin incision, 3 min after delivery, end of operation. Results No significant difference between two groups were observed in total infusion, usage of vasoaetive drugs, heart rate and thoracic fluid content （ P 〉 0. 05 ）. Cardiac output and stroke volume showed statistically significant differences at various time points within each group （ P 〈 0. 05 ） but not between groups（P 〉0. 05）. Blood pressure and total peripheral resistance in the supine group were significantly decreased when compared with the left tilt group after anesthesia （ P 〈 0. 05 ）. Conclusion There is dramatic hemodynamic fluctuation during cesarean section under combined spinal - epidural anesthesia, which mainly occurs after anesthesia and around de- livery of the baby, and it needs to be monitored real -time and accurately. Assuming a left tilt 15 -degree position with proper fluid therapy and anesthesia management can minimize hypotension occurrence.

关 键 词：椎管内麻醉 血流动力学 无创监测 剖宫产 体位 

分 类 号：R614.4[医药卫生—麻醉学]