动脉压力波形心排量监测在凶险性前置胎盘剖宫产术中的应用  

Use of arterial pressure-based cardiac output in cesarean section for pernicious placenta previa Wu

作　　者：伍惠仪[1] 余碧琳[1] 杨梅娟[1] 苏志源[1] 陈郡兴[1] 王寿平[1] 詹鸿[1] 

机构地区：[1]广州医科大学附属第三医院麻醉科,广州510150

出　　处：《中华生物医学工程杂志》2017年第3期230-234,共5页Chinese Journal of Biomedical Engineering

摘　　要：目的 探讨动脉压力波形心排量（APCO）监测指导急性超容性血液稀释（AHHD）用于凶险性前置胎盘剖宫产术中的有效性.方法 收集2016年8月至2017年2月本院收治的凶险性前置胎盘择期全麻下行剖宫产术的单胎妊娠产妇17例,所有患者均监测APCO,麻醉诱导后按20～30 ml/kg进行血液稀释,根据每搏变异度（SVV）和每搏量指数（SVI）调整液体输注速度,控制扩容时间在60 min内.记录全麻诱导后（血液稀释前,T0）、胎儿娩出前（血液稀释后,T1）、剥离胎盘时（开始出血时,T2）、开始输血时（出血量较大时,T3）、关腹时（输血完毕,T4）各时点的血流动力学指标,包括心率、平均动脉压（MAP）、中心静脉压（CVP）、SVV、SVI、心指数（CI）、外周血管阻力（SVR）等,并进行血气分析.结果 T1时点CVP较T0时点升高,T2～T4时点CVP较T1时点均下降（均P〈0.05）.T1～T3时点CI较T0时点增加,T1～T4时点SVI较T0时点增加（均P〈0.05）,而T2～T4时点CI、SVI较T1时点均无显著变化（均P〉0.05）.T1时点SVV较T0时点降低,T3时点SVV较T1时点升高（均P〈0.05）.T1、T2时点SVR较T0时点下降（均P〈0.05）.T1～T4时点红细胞压积（Hct）和血红蛋白（Hb）较T0时点均降低（均P〈0.05）,而T2～T4时点Hct、Hb与T1时点比较差异无统计学意义（均P〉0.05）.血气分析显示,T1时点血Na^＋、K^＋、Ca^2＋和血糖与T0时点比较,差异无统计学意义（均P〉0.05）;T1～T4时点血pH值和碱剩余较T0时点降低（均P〈0.05）.所有患者均需输注血制品.结论 APCO指导下行AHHD能有效维持患者术中血流动力学和内环境稳定.Objective To investigate the effect of acute hypervolumic hemodilution（AHHD）in cesarean section for pernicious placenta previa via arterial pressure-based cardiac output（APCO）. Methods Seventeen singleton pregnant women with pernicious placenta previa,who underwent selective cesarean section with general anesthesia in our hospital between August 2016 and February 2017,were included in the study. All patients were monitored for APCO,and the blood was diluted by 20 to 30 ml/kg after anesthesia induction. The fluid infusion rate was adjusted according to the stroke volume variation（SVV）and stroke volume index（SVI）,and the expansion time was controlled within 60 min. The hemodynamic parameters, such as heart rate,mean arterial pressure（MAP）,central venous pressure（CVP）,SVV,SVI,cardiac index（CI）,systemic vascular resistance（SVR）at each time points,including after the induction of general anesthesia（before blood dilution,T0）,before the fetal delivery（after blood dilution,T1）,when separating the placenta（when bleeding,T2）,when beginning blood transfusion（when the blood loss was large,T3）, and when closing the abdominal cavity（the blood transfusion was completed,T4）,were recorded. The blood gas analysis was performed at each time points also. Results The CVP at T1 increased compared with that at T0,whereas increased compared with that at T2-T4（all P〈0.05）. The CI increased at T1-T3 compared with that at T0,and the SVI increased at T1-T4 compared with that at T0（all P〈0.05）. There were no significant changes in the CI and SVI between T2-T4 and T1（all P〉0.05）. The SVV at T1 was lower than that at T0, and the SVV at T3 was higher than that at T1（both P〈0.05）. The SVR at T1 and T2 decreased compared with that at T0（both P〈0.05）. The haematocrit（Hct）and hemoglobin（Hb）at T1-T4 decreased compared with those at T0（all P〈0.05）,whereas there were no statistically significant differences in the Hct and Hb between T2-T4 and T1 （all P〉

关 键 词：血液稀释 动脉压力波形心排量监测 凶险性前置胎盘 剖宫产术 血流动力学 

分 类 号：R614[医药卫生—麻醉学]