术前体位改变对剖宫产腰麻后引起低血压的预测分析  

Prediction of Hypotension during Spinal Anesthesia for Elective Cesarean Section by Altered Heart Rate Variability Induced by Postural Change

作　　者：陈烨 邹聪华 陈彦青 

机构地区：[1]福建省立金山医院,福建福州350000

出　　处：《中国医学创新》2017年第30期19-22,共4页Medical Innovation of China

摘　　要：目的:探索术前体位改变引起的心率变异性能否预测剖宫产腰麻后的低血压。方法:随机选择50例产妇在腰麻下进行择期剖宫产术,在剖宫产前1 d进行了体位变化检查。按仰卧位、左侧卧位和仰卧位的顺序记录无创血压(NIBP)、心率(HR)、心电图(ECG)和LF/HF比。采用5 min记录1次参数,在每个位置记录BP 3次,持续监测心电图。为了分析心率变异性,从监护仪获得ECG信号,并将其输入到计算机中以分析RR间期。使用Mem Calc软件进行心率变异性(HRV)分析,每5秒计算1次LF、HF和LF/HF(低高频率比),在第1次仰卧位记录的LF/HF值作为对照值(基线LF/HF)。从左侧卧位到仰卧位时,LF/HF比增长2倍以上的产妇分到阳性组,2倍以下分到阴性组。手术当天的产妇均进行ECG、HR、NIBP和氧饱和度的监测,并在仰卧位静脉滴注晶体液[4~6 m L/(kg·h)]。产妇仰卧时测的HR和BP为基线值。取左侧卧位,L3~4间隙进行腰麻,药物为0.75%罗哌卡因2 m L,注射后产妇转为平卧位。每分钟测量无创血压,直到血压平稳。结果:根据体位改变检测结果,将产妇分为阳性组(23例)和阴性组(26例),71.4%(35/49)产妇发生低血压,阳性组占60.0%(21/35),阴性组占40.0%(14/35)。PCT阳性组低血压发生率为91.3%(21/23),高于阴性组的53.8%(14/26),差异有统计学意义(P<0.01)。在腰麻(SA)剖宫产期间,PCT预测产妇低血压的敏感性和特异性分别为60.0%[95%CI(52.4,62.3)]和87.5%[95%CI(63.5,98.2)]。PCT的阳性预测值(PPV)和阴性预测值(NPV)分别为91.3%[95%CI(52.4,62.3)]和53.8%[95%CI(37.6,55.7)]。PCT作为产妇低血压的预测因子为0.76[95%CI(0.60,0.92)]。结论:术前体位改变引起的心率变化可预测剖宫产腰麻后低血压。Objective：To investigate the effect of the postural change test with heart rate variability to predict the risk of hypotension during spinal anesthesia for cesarean section.Method：A total of 50 women scheduled to undergo cesarean section under spinal anesthesia were enrolled,a postural change test was performed the day before cesarean section.Non-invasive BP （NIBP） on the left arm,HR,electrocardiogram （ECG） and LF/HF ratio were recorded in the order of supine position,left lateral position and supine position.Each position was adopted for 5 min to record each parameter,blood pressure was recorded three times in each position,the ECG and HR were continuously monitored.In order to analyze heart rate variability,the ECG signal was obtained from the monitor and input into the computer to analyze the RR interval.Heart rate variability （HRV） analysis was performed using MemCalc software,the first time LF,HF and LF/HF （low to high frequency ratio） were calculated every 5 seconds,and the LF/HF value recorded in the first supine position was used as the control value （baseline LF/HF）.From left recumbent position to supine position,LF/HF was more than 2 times allocated to the positive group,less than 2 times allocated to the negative group.On the operating day,all patients were monitored via ECG,HR,NIBP,oxygen saturation,and received intravenous crystalloid [4-6 mL/（kg·h）] in the supine position.We regarded HR and BP measured in the operating room just after lying supine on the operating room bed as baseline values.In all cases,SA was performed at the L3-4 interspace with the patient in the left lateral position.Hyperbaric 0.75% Ropivacaine 2 mL was administered through a spinal needle.Following injection,patients were immediately turned supine from the left lateral position,non-invasive BP was measured every minute until BP stabilized.Result：According to the result of body position change test,the pregnant women were divided into positive group （23 cases） and negative group （26 cases�

关 键 词：低血压 心率变异性 体位改变试验 剖宫产 

分 类 号：R614[医药卫生—麻醉学]