羟乙基淀粉130/0.4氯化钠注射液预扩容对腰硬联合麻醉下剖宫产患者血流动力学的影响  

Effects of the pre-expansion of hydroxyethyl starch 130/0.4 sodium chloride injection on hemodynamics during cesarean section under spinal-epidural anesthesia

作　　者：陈勇[1] 夏克枢[1] 陈涛[1] CHEN Yong XIA Ke-shu CHEN Tao(The Third People＇s Hospital of Cheng＇du, Chengdu, Sichuan 610000, China)

机构地区：[1]成都市第三人民医院麻醉科,四川成都610000

出　　处：《中国预防医学杂志》2016年第10期768-771,共4页Chinese Preventive Medicine

摘　　要：目的观察比较羟乙基淀粉130/0.4氯化钠注射液和林格氏液预扩容对腰硬联合麻醉下剖宫产产妇血流动力学的影响。方法将2014年3月至2015年7月,成都市第三人民医院择期行腰硬联合麻醉下剖宫产手术的孕妇170例随机分为对照组与观察组,每组85例。对照组给予乳酸林格氏液500ml预扩容,观察组给予6%羟乙基淀粉130/0.4氯化钠注射液500ml预扩容。于入室5min后(T0)、扩容后(T1)、注入麻醉后5min(T2)、切皮时(T3)、胎儿剖出时(T4)、手术结束后(T5),测量各时点血流动力学指标。比较两组患者麻黄碱用量、新生儿apgar评分和脐带血气指标的差异。结果两组患者在T2时的MAP、CO、SV、SVR差异均有统计学意义(P<0.05),T3时的MAP、HR、CO、SV、SVR差异均有统计学意义(P<0.05),T4时的CO、SV、SVR差异均有统计学意义(P<0.05)。对照组患者麻黄碱用量(7.45±1.32)mg,观察组(3.58±1.16)mg,两组比较差异有统计学意义(t=3.624,P<0.05)。结论羟乙基淀粉130/0.4氯化钠注射液预扩容有助于维持腰硬联合麻醉下剖宫产患者血流动力学的稳定,增加胎盘血流量,减少血管升压药用量。Objective To observe the effects of pre-expansion of hydroxyethyl starch 130/0.4sodium chloride injection on hemodynamics during cesarean section under spinal-epidural anesthesia. Methods 170 pregnant women scheduled for cesarean section were collected from the Third People＇s Hospital from March 2014 to July2015and randomly divided into two groups,85 per group,and were treated with either 500 ml of hydroxyethyl starch 130/0.4sodium chloride injection or 500 ml of Ringers solution prior to anesthesia over a period of 30 minutes.The mean arterial pressure（MAP）,heart rate（HR）,cardiac output（CO）,stroke volume（SV）and systemic vascular resistance（SVR）were recorded and compared at 5min entering into the room（T0）,after expansion（T1）,5min after anesthesia（T2）,the beginning of skin disinfection（T3）,right after the delivery（T4）and at the end of operation（T5）.The dosage of ephedrine,blood analysis of umbilical cord and apgar score were compared,as well. Results The differences of MAP,CO,SV and SVR in T2,MAP,HR,CO,SV and SVR in T3,CO,SV and SVR in T4 were all statistically significant between two groups（P〈0.05）.Meanwhile,the difference of dosage of ephedrine was significant（7.45±1.32 vs 3.58±1.16 mg,t=3.624,P〈0.05）. Conclusions The pre-expansion of hydroxyethyl starch 130/0.4sodium chloride injection can improve the hemodynamics and keep the homeostasis which increases the uteroplacental blood flow and decreases vasopressors usages.

关 键 词：羟乙基淀粉130/0.4氯化钠注射液 腰硬联合麻醉 剖宫产 血流动力学 

分 类 号：R614[医药卫生—麻醉学]