斜坡形垫架在预防剖宫产仰卧位低血压综合征中的应用  

Application of gradient cushion on prevention of supine hypotension syndrome undergoing cesarean section

作　　者：刘俭 李芳[1] 黄琦 农喜敏 刘姿[1] Liu Jian;Li Fang;Huang Qi;Nong Ximin;Liu Zi(Operation Room,Langdong Hospital,No.1 People′s Hospital of Nanning,Nanning 530029,China)

机构地区：[1]南宁市第一人民医院埌东医院手术室,530029

出　　处：《中国实用护理杂志》2020年第5期386-390,共5页Chinese Journal of Practical Nursing

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z2016145)。

摘　　要：目的观察斜坡形垫架在预防剖宫产仰卧位低血压综合征(SHS))中的应用效果。方法在腰硬联合麻醉下行剖宫产术产妇450例,采用随机数字表法分为斜坡形垫架组(A组)、砂袋组(B组)和手术床左倾斜组(C组),每组150例。腰硬联合麻醉成功后对3组进行体位干预。记录3组麻醉后发生SHS例数,麻醉前及麻醉后2 min、5 min、10 min、胎儿取出前的收缩压(SBP)、舒张压(DBP)、心率(HR)、呼吸频率(RR)和脉搏血氧饱和度(SpO2),采用手术体位舒适性量表评估体位摆放舒适度。结果A、B、C组SHS发生率分别为8.0%(12/150)、20.0%(30/150)、21.3%(32/150),其中A组SHS发生率低于B组和C组,差异有统计学意义(χ^2值为8.970、10.653,均P<0.01)。A、B、C组舒适性量表评分分别为(47.03±3.01)、(38.13±4.70)、(36.10±4.04)分,A组舒适性量表评分高于B、C组,B组舒适性量表评分高于C组,差异有统计学意义(t值为27.413、30.227、2.542,P<0.01或0.05)。A、B组在麻醉后2、5、10 min和胎儿取出前的SBP和DBP均高于C组,A组在麻醉后2、5、10 min和胎儿取出前的SBP和DBP均高于B组,A、B组在麻醉后2、5、10 min和胎儿取出前的HR和RR均低于C组,A组在麻醉后2、5、10 min和胎儿取出前的HR和RR均低于B组,差异有统计学意义(t值为-15.842~21.117,P<0.05或0.01)。结论在腰硬联合麻醉后应用斜坡形垫架进行体位调整可有效降低剖宫产术中SHS发生,不仅操作简便,还可减少产妇体位改变和提高体位摆放后舒适度。Objective To investigate the application of gradient cushion on prevention of supine hypotension syndrome(SHS)undergoing cesarean section.Methods 450 parturients undergoing cesarean section with spinal and epidural anesthesia,aged 20-45 years,ASAⅠ,ⅡorⅢgrades,were randomly assigned into three groups:gradient cushion group(group A),sandbag group(group B)and left-leaning-operating table group(group C),150 cases in each.The posture intervention was alternated after completion of spinal and epidural anesthesia.Recorded the cases of SHS,and collected systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),respiratory rate(RR)and saturation of pulse oximetry(SpO2)before anesthesia,2 min,5 min,10 min after anesthesia and prefetus removal from uterus.And assessed the position comfort with surgical posture comfort scale.Results The incidence of SHS in group A was 8.0%(12/150),in group B was 20.0%(30/150),and in group C was 21.3%(32/150).The rate of SHS was higher in group A than other groups(χ^2 value was 8.970,10.653,all P<0.01).The score with surgical posture comfort scale was(47.03±3.01),(38.13±4.70),(36.10±4.04),which was higher in group A than group B or group C,and the score with surgical posture comfort scale was higher in group B than group C(t value was 27.413,30.227,2.542,P<0.01 or 0.05).SBP and DBP were higher in group A and group B than group C at 2 min,5 min,10 min after anesthesia and prefetus removal from uterus,and SBP and DBP were higher in group A than group B at 2 min,5 min,10 min after anesthesia and prefetus removal from uterus,HR and RR were higher in group A and group B than group C at 2 min,5 min,10 min after anesthesia and prefetus removal from uterus,and HR and RR were higher in group A than group B at 2 min,5 min,10 min after anesthesia and prefetus removal from uterus(t value was-15.842-21.117,P<0.05 or 0.01).Conclusion After spinal and epidural anesthesia,applying the gradient cushion for adjustment of position would be effective to reduce the occurrence of SHS,simpl

关 键 词：仰卧位低血压综合征 剖宫产术 腰硬联合麻醉 舒适度 斜坡形垫架 

分 类 号：R614[医药卫生—麻醉学]