剖宫产术体位护理干预联合超声检测下腔静脉及子宫动脉的研究  

Study of postural nursing intervention combined with ultrasonic examination of inferior vena cava and uterine artery in caesarean section

作　　者：薛勤[1] 景孜涵 蔺大明[1] 郭然 蒋美琴[1] XUE Qin;JING Zi-han;LIN Da-ming;GUO Ran;JIANG Mei-qin(Jiangyin Hospital Affiliated to Medical College of Southeast University,Jiangyin Jiangsu 214400,China;China Medical University,Shenyang 110113,China;Department of Anesthesia and Pain,Zhejiang Provincial People’s Hospital,Hangzhou 310014,China)

机构地区：[1]东南大学医学院附属江阴医院,江苏江阴214400 [2]中国医科大学,辽宁沈阳110113 [3]浙江省人民医院麻醉疼痛科,浙江杭州310014

出　　处：《中国临床医学影像杂志》2021年第9期648-651,655,共5页Journal of China Clinic Medical Imaging

基　　金：无锡市卫生健康委员会科技成果与适宜技术推广项目(T202027);江阴市卫生健康委员会指导性科研项目(G201801)。

摘　　要：目的:为预防腰麻后剖宫产孕妇低血压的发生,探讨孕妇进行左侧卧位15°体位护理干预的效果,并观察孕妇下腔静脉及子宫动脉的血流动力学差异。方法:选择健康足月妊娠拟行剖宫产孕妇70例,随机分为A、B两组(每组35例)。A、B组孕妇腰麻后分别采取平卧位及左侧卧位15°,记录两组孕妇剖宫术中低血压(SBP<80%基础值)的发生率,如发生低血压即用去氧肾上腺素处理。腰麻后应用超声检测两组孕妇的下腔静脉(呼气末内径及最高流速)及子宫动脉血流动力学参数,包括阻力指数(RI)、搏动指数(PI)及S/D(PSV/EDV)值。结果:A组低血压发生率高于B组(22.9%vs 2.9%,P<0.05);下腔静脉内径中位数小于B组((1.37(1.21,1.60))cm vs(1.67(1.56,1.90))cm,P<0.05);两组间的子宫动脉RI、PI及S/D差异均无统计学意义(P>0.05)。结论:左侧卧位能降低腰麻后剖宫产孕妇低血压发生率,一旦发生,临床及时处理并不影响妊娠子宫血流灌注,其机制通过超声观察子宫动脉得以证实。Objective:To investigate the effect of nursing intervention of pregnant women in left decubitus position 15°in order to prevent hypotension in pregnant women with caesarean section after spinal anesthesia,and observe the hemodynamic changes of inferior vena cava and uterine artery in pregnant women.Methods:Seventy healthy full-term parturients selected for cesarean section were randomly divided into group A and group B(35 cases in each group).After the spinal anesthesia,the pregnant women in group A and group B were in supine position and left lateral position for 15°respectively,the incidence of hypotension(defined as SBP<80%of the baseline)were recorded,norepinephrine was used if hypotension occurred.The hemodynamic parameters of the inferior vena cava(end expiratory diameter and maximum velocity)and uterine artery,including resistance index(RI),pulse index(PI)and S/D(PSV/EDV),were detected by ultrasonography after spinal anesthesia in two groups of pregnant women.Results:The incidence of hypotension in group A was higher than that in group B(22.9%vs2.9%,P<0.05).Median diameter of inferior vena cava was less than that of group B((1.37(1.21,1.60))cm vs(1.67(1.56,1.90))cm,P<0.05).There was no significant difference in RI,PI and S/D of uterine artery between the two groups(P>0.05).Conclusions:Left lateral decubitus can reduce the incidence of hypotension in pregnant women after spinal anesthesia during cesarean section.Once it occurs,the timely clinical treatment does not affect uterine blood perfusion.The mechanism was confirmed by ultrasound observation of uterine artery.

关 键 词：剖宫产术 腔静脉 下 子宫动脉 血流动力学 超声检查 

分 类 号：R719.8[医药卫生—妇产科学] R543.6[医药卫生—临床医学]