腰硬联合麻醉下剖宫产对重度子痫前期患者血流动力学的影响  

Effect of epidural anesthesia for cesarean section on hemodynamics of patients with severe pre-eclampsia

作　　者：施秀亚 胡华敏[2] 封英[3] 

机构地区：[1]宁海县妇幼保健院(浙江大学附属妇产科医院宁海分院)麻醉科,浙江宁波315600 [2]浙江省台州医院妇科,浙江台州317000 [3]浙江大学医学院附属妇产科医院麻醉科,浙江杭州310006

出　　处：《中华全科医学》2016年第12期2067-2069,共3页Chinese Journal of General Practice

基　　金：2014年浙江省科技厅公益技术研究社会发展项目(2014C33171)

摘　　要：目的探讨重度子痫前期孕妇腰硬联合麻醉下剖宫产对血流动力学的影响。方法选择2013年4月—2014年3月宁海县妇幼保健院重度子痫前期孕妇90例作为实验组,健康孕妇90例作为对照组,2组孕妇均行腰硬联合麻醉剖宫产,观察2组孕妇麻醉前后血压和心率的变化情况、新生儿出生体重和Apgar评分情况、低血压发生情况。结果实验组孕妇麻醉中输液量[(1 067.0±315.0)ml]、利多卡因用量[(4.5±2.7)ml]和麻黄素用量[(6.5±2.9)mg]均低于对照组[(1 358.0±322.0)ml、(7.3±3.1)ml、(14.1±6.7)mg)],P<0.05。实验组新生儿出生体重为(1 975±675)g,低于对照组的(3 214±602)g(P<0.05),实验组新生儿1 min Apgar评分≤7分所占比例(28.9%)高于对照组(12.2%,P<0.05),实验组新生儿5 min Apgar评分≤7分所占比例高于对照组,但2组差异没有统计学意义(P>0.05)。实验组孕妇麻醉前血压、麻醉后最低血压、麻醉前血压-麻醉后最低血压均明显高于对照组(P<0.05)。实验组孕妇麻醉前心率、麻醉后最低心率、麻醉前心率-麻醉后最低心率[(98.2±15.7)、(82.9±16.3)、(16.7±11.6)次/min]均明显高于对照组[(82.6±11.5)、(76.1±13.8)、(6.5±10.4)次/min](P<0.05)。实验组低血压的发生率(68.9%)明显高于对照组(35.6%),P<0.05。结论重度子痫前期孕妇腰硬联合麻醉下剖宫产低血压的发生率较高,术中需注意预防低血压的发生。Objective To investigate the effect of epidural anesthesia for cesarean section on hemodynamics of patients with severe pre-eclampsia. Methods Selected 90 cases of severe preeclampsia as the experimental group,90 cases of healthy pregnant women as the control group from April, 2013 to March, 2014 in Ninghai County MCH. The pregnant women in two groups were cesarean section underwent epidural anesthesia. The changes of blood pressure and heart rate before and after anesthesia, birth weight and Apgar score and the situation hypotension were observed in two groups pregnant women. Results The infusion volume （ 1 067 ± 315 ） ml, the amount of lidoeaine （ 4.5 ± 2.7 ） ml and ephedrine （6.5 ± 2.9 ）mg in anesthesia of experimental group pregnant women were lower than that of the control group （ 1 358.0 ± 322.0） ml, （7.3 ± 3.1 ） ml, （ 14.1 ±6.7） mg （ P 〈 0.05 ）. The birth weight in the experimental group （975 ± 675 ） g was lower than that of the control group（3 214 ±602）g（P 〈0.05） ,the newborns 1 min Apgar score ≤7 proportion in the experimental group （28.9%） was higher than that of the control group （12.2 %, P 〈 0.05 ）, the newborns 5 min Apgar score ≤7 proportion in the experimental group was higher than that of the control group ,but the difference was not statistically significant（ P 〉 0.05 ）. Systolic blood pressure and diastolic blood pressure ：tbe blood pressure before anesthesia, the minimum blood pressure after anesthesia, blood pressure before anesthesia-minimum blood pressure after anesthesia of experimental group pregnant women were significantly higher that of the control group（ P 〈 0.05 ）. The heart rate before anesthesia, the minimum heart rate after anesthesia, heart rate before anesthesia-minimum heart rate after anesthesia of experimental group pregnant women[ （98.2 ± 15.7,82.9 ± 16.3,16.7 ± 11.6） times/mini were significantly higher than those of the control group [ （ 82.6 ± 11.5,76.1 ± 13.8,6.5 ± 10.4） times/mi

关 键 词：剖宫产 腰硬联合麻醉 重度子痫前期 血流动力学 

分 类 号：R714.245[医药卫生—妇产科学] R719.8[医药卫生—临床医学]