连续无创血压监测系统在产科麻醉的应用  

The application of continuous noninvasive arterial pressure measurement device in obestric anesthesia

作　　者：杨秀环[1] 梁华杰[1] 梁秀生[1] 林宗航[1] 陆文敏[1] 苏适夷 李恒[1] YANG Xiuhuan;LIANG Huajie;LIANG Xiusheng;LIN Zonghang;LU Wenmin;SU Shiyi;LI Heng(Department of Anesthesia, the Sixth Affiliated Hospital of Guangzhou Medical University (Qingyuan People′s Hospital),Qingyuan,Guangdong 511518,China)

机构地区：[1]广州医科大学附属第六医院(清远市人民医院)麻醉科,广东清远511518

出　　处：《岭南现代临床外科》2017年第5期551-554,共4页Lingnan Modern Clinics in Surgery

基　　金：清远市科技计划项目(2015B025)

摘　　要：目的探讨连续无创血压监测系统(CNAP)CNAP^(TM)monitor 500比较传统的无创袖带血压(NIBP)监测系统应用于腰硬联合麻醉后剖宫产监测低血压发生的时效性。方法选择85例产妇在腰硬联合麻醉下行剖宫产术。总共有1040对产妇的收缩压和舒张压被监测,间隔周期为3 min,观察时间为麻醉前到胎儿娩出后,并记录新生儿的脐静脉血气分析和Apgar评分。结果相比NIBP,每一周期CNAP能监测的最低收缩压平均值(103±20.6 mmHg)明显低于(P<0.05)NIBP的平均值(116±17.9 mmHg)和最高的CNAP收缩压平均值(120±19.6 mmHg)。低血压定义为收缩压低于90 mmHg,CNAP监测组低血压的发生率70.58%,而NIBP监测组低血压的发生率为35.29%。当CNAP监测的低血压(收缩压为<90 mmHg)时,未发现胎儿酸中毒(脐静脉血p H值<7.25)。结论 CNAP能够比NIBP监测出更多的低血压事件,而且动脉血压明显低于NIBP监测系统。从胎儿利益的角度出发,CNAP的监测比NIBP更适于需要腰硬联合的产科手术。Objective To investigate the reliability of continuous noninvasive arterial pressure measurement device(CNAP)CNAP?monitor500for detecting hypotensive episodes for caesarean section in spinal anesthesia(SPA).Methods Eighty?five women undergoing caesarean section under SPA were included in the study analysis.A total of1040NIBP measurements were obtained at3mincycles,starting from before SPA,continuous noninvasive arterial pressure measurement until delivery.Blood gas analysis of umbilical vein in neonates was analyzed,and Apgar score of neonates were recorded.Results When averaged over all cycles,the lowest systolic BP identified by CNAP in each cycle(103±20.6mmHg)was significantly lower than the average of the NIBP measurements(116mmHg±17.9mmHg)and highest CNAP average(120±19.6mmHg)(all P values<0.05).Hypotension(systolic BP<90mmHg)was detected in70.58%of the patients based on CNAP and in35.29%based on NIBP.Fetal acidosis defined by an umbilical vein pH under7.25did not occur when the lowest systolic BP measured by CNAP was under90mmHg.Conclusions The CNAP device detected more hypotensive episodes after SPA and lower BP when compared with NIBP.BP monitoring based on CNAP may improve hemodynamic management in the patient population with potential benefit for the fetus.

关 键 词：产科麻醉 血压 低血压 监测技术 

分 类 号：R614[医药卫生—麻醉学]