左侧倾斜30°位对剖宫产产妇术中低血压发生率及新生儿窒息评分的影响  

Effect of left oblique 30 degress position on incidence rate of intraoperative hypotension and neonatal asphyxia score in pregnant women undergoing cesarean section

作　　者：汤琼瑶 李建[1] TANG Qiong-Yao;LI Jian.(Department of Anesthesiology, Operating Room, Haikou Maternal and Child Health Care Hospital, Haikou, Hainan 570203, Chin)

机构地区：[1]海口市妇幼保健院手术室麻醉科,海南海口570203

出　　处：《中国妇幼保健》2018年第11期2414-2418,共5页Maternal and Child Health Care of China

基　　金：海南省卫生计生委科研课题(16A200053)

摘　　要：目的对比分析左侧倾斜30°位与常规平卧位对行椎管内麻醉的剖宫产产妇术中低血压发生率及新生儿窒息评分的影响,为改善剖宫产术安全性提供一定的理论指导。方法分析2016年5月-2017年5月在海口市妇幼保健院妇产科接受剖宫产术分娩的164例产妇的临床资料。随机将入选者分为观察组(左侧倾斜30°位)和对照组(常规平卧位),每组各82例。比较两组患者的一般资料、不同时刻[包括麻醉前(T0)、麻醉后即刻(T1)、麻醉后5 min(T2)、麻醉后10 min(T3)、麻醉后15 min(T4)、胎儿娩出时(T5)]血流动力学[包括收缩压(SBP)、心率(HR)及血氧饱和度(SpO_2)]变化、胎儿脐动脉血气分析结果及新生儿Apgar评分、低血压发生率。结果两组产妇不同时刻的SpO_2水平比较,差异无统计学意义(P>0.05);T3时点观察组产妇的HR值明显低于对照组(P<0.05),T1~T5时点观察组产妇的SBP较平稳,但对照组产妇的SBP波动较大。观察组胎儿的PaO_2水平明显高于对照组,PaCO_2水平明显低于对照组(P<0.05);两组胎儿的p H值比较,差异无统计学意义(P>0.05)。观察组产妇低血压发生率明显低于对照组(P<0.05);两组新生儿Apgar评分比较,差异无统计学意义(P>0.05)。结论与常规平卧位相比,左侧倾斜30°位可明显降低剖宫产产妇术中低血压发生率,对新生儿窒息评分无明显影响,值得推广。Objective To compare and analyze the effects of left oblique 30 degress position and normal supine position on incidence rate of intraoperative hypotension and neonatal asphyxia score in pregnant women undergoing cesarean section with intraspinal anesthesia.Methods The clinical data of 164 pregnant women undergoing cesarean section in Department of Gynecology and Obstetrics in Haikou Maternal and Child Health Care Hospital from May 2016 to May 2017 was analyzed,then the cases were divided into observation group（ left oblique 30 degress position） and control group（ normal supine position）,82 cases in each group. The general information,changes of systolic pressure（ SBP）,heart rates（ HR）,and oxyhemoglobin saturations（ SpO2） before anesthesia（ T0）,the immediate time after anesthesia（ T1）,at 5 minutes after anesthesia（ T2）,at 10 minutes after anesthesia（ T3）,at 15 minutes after anesthesia（ T3）,and the time of delivery of baby,the results of fetal umbilical arterial blood gas analysis,neonatal Apgar scores,the incidence rates of hypotension in the two groups were compared. Results There was no statistically significant difference in SpO2 levels at different time points between the two groups（ P〈0. 05）. HR at T3 time point was statistically significantly lower than that in control group（ P〈0. 05）,SBP values at different time points in observation group were stable,while SBP values in control group varied significantly. PaO2 level of fetuses in observation group was statistically significantly higher than that in control group,while the level of PaCO2 in observation group was statistically significantly lower than that in control group（ P〈0. 05）. There was no statistically significant difference in p H value between the fetuses in the two groups（ P〈0. 05）. The incidence rate of hypotension in observation group was statistically significantly lower than that in control group（ P〈0. 05）. There was no statistically significant difference in neonatal Apgar

关 键 词：剖宫产 低血压 新生儿窒息 仰卧位 左侧倾斜30°位 

分 类 号：R173[医药卫生—妇幼卫生保健]