子痫前期产妇剖宫产术中同步输注胶体与晶体液的临床效果及安全性比较  

Comparison of clinical efficacy and safety of synchronous injection of colloid versus crystalloid solution during cesarean section in preeclampsia puerperas

作　　者：沈冬梅 杨淑芳 余艳 SHEN Dong-mei;YANG Shu-fang;YU Yan(Department of Obstetrics and Gynaecology,Gaochun Branch of Nanjing Drum Tower Hospital,Nanjing 211300,China)

机构地区：[1]江苏省南京鼓楼医院高淳分院妇产科,南京市211300

出　　处：《广西医学》2021年第2期151-154,共4页Guangxi Medical Journal

基　　金：江苏省卫生计生委面上科研课题(H201646)。

摘　　要：目的比较子痫前期产妇剖宫产术中同步输注胶体与晶体液的临床效果及安全性。方法纳入204例子痫前期产妇,均于腰硬联合麻醉下初次行剖宫产术。依据术中输注液体类型将产妇分为胶体组93例和晶体组111例。胶体组产妇术中输注琥珀酰明胶注射液,晶体组产妇术中输注乳酸林格氏液。比较两组产妇术中情况、术前和术后24 h血常规及凝血功能,以及新生儿出生后Apgar评分。结果胶体组术中最低收缩压、最低舒张压及尿量均高于或多于晶体组(P<0.05),但两组术中低血压发生率、麻黄碱及去甲肾上腺素使用率、呼吸困难及过敏反应发生率比较,差异均无统计学意义(均P>0.05)。胶体组凝血酶时间、凝血酶原时间、活化部分凝血活酶时间长于晶体组,而血小板计数及纤维蛋白原水平则低于晶体组(均P<0.05)。两组产妇手术前后的血红蛋白和红细胞计数、新生儿Apgar评分差异均无统计学意义(均P>0.05)。结论胶体液同步扩容在预防子痫前期产妇腰硬联合麻醉所致低血压方面的效果优于晶体液,但可能对产妇凝血功能产生一定影响。Objective To compare the clinical efficacy and safety of synchronous injection of colloid versus crystalloid solution during cesarean delivery in puerperas with preeclampsia.Methods Totally 204 puerperas with preeclampsia,who received the first cesarean delivery under combined spinal and epidural anesthesia,were enrolled.According to the type of intraoperative infusion solution,the puerperas were divided into colloid group(n=93)and crystalloid group(n=111).The colloid group and the crystalloid group received intraoperative infusion of Succinylated Gelatin Injection and Lactated Ringer′s Solution,respectively.A comparison was conducted between the two groups in terms of intraoperative condition,preoperative and postoperative 24-hour blood routine test and coagulation function of the puerperas,and neonatal Apgar score after birth.Results The lowest systolic/diastolic blood pressure and urine volume in the colloid group were higher or more than those in the crystalloid group(all P<0.05).However,there was no statistically significant difference between the two groups in incidence rate of intraoperative hypotension,dose of ephedrine or phenylephrine use,or incidence rate of dyspnea or allergic reaction(all P>0.05).By comparison with the crystalloid group,the colloid group obtained prolonged thrombin time,prothrombin time and activated partial thromboplastin time,and lower platelet count and fibrinogen level(all P<0.05).No statistically significant difference was found between the two groups in preoperative or postoperative hemoglobin or RBC count,or neonatal Apgar score(all P>0.05).Conclusion Synchronous dilatation with colloid solution exerts a better effect on preventing hypotension caused by combined spinal and epidural anesthesia in preeclampsia puerperas as compared with crystalloid solution,but it may affect puerperal coagulation function to some extent.

关 键 词：子痫前期 剖宫产术 琥珀酰明胶注射液 乳酸林格氏液 同步扩容 腰硬联合麻醉 低血压 凝血功能 

分 类 号：R719.8[医药卫生—妇产科学] R714.25[医药卫生—临床医学]