压力记录分析法在肺动脉高压产妇剖宫产术中的应用  

The use of pressure-recording analytical method in pregnant women with or without severe pulmonary hypertension undergoing caesarean section

作　　者：林培容[1] 李响[1] 马骏[1] 赵丽云[1] LIN Peirong;LI Xiang;MA Jun;ZHAO Liyun(Department of Anesthesiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京心肺血管疾病研究所麻醉科,100029

出　　处：《心肺血管病杂志》2022年第6期662-665,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨应用压力记录分析法(PRAM)研究妊娠合并重度肺动脉高压与肺动脉压力在正常产妇择期行子宫下段横切口剖宫产术术中血流动力学变化。方法:回顾性分析于北京安贞医院诊断合并有心脏疾患并接受剖宫产手术的患者24例,根据患者肺动脉压力分为重度肺高压组(S组,12例)与正常组(N组,12例)。比较两组一般临床情况;麻醉前(T1)、麻醉后3min(T2)、胎儿剖出前(T3)、胎儿剖出后5min(T4)和出室时(T5)的血流动力学指标水平;记录临床转归。结果:术前S组患者的NYHA分级差于N组患者(P<0.01)。S组SysP在T1及T2时刻显著低于N组;S组Dic P在T1及T2时刻显著低于N组;S组HR在T4时刻显著高于N组;S组CCE在T2及T4时刻显著低于N组;S组Dp/dtmax在T1及T2时刻显著低于N组;S组PPV在T5时刻显著高于N组。S组总住院时间显著长于N组,差异有统计学意义(P<0.05)。结论:压力记录分析法可以较为准确及客观的反应,妊娠合并肺动脉高压产妇剖宫产术中血流动力学的变化;对于妊娠合并重度肺动脉高压的产妇,分娩前其血流动力学更不稳定,对于血流动力学的调节能力更差,围手术期需要更精细的管理。Objective: To evaluate hemodynamic changes of pregnant women with or without severe pulmonary hypertension(PH) undergoing caesarean section by using pressure-recording analytical method(PRAM). Methods: 24 pregnant women with cardiac disease were enrolled in this study. They were divided into severe PH group(group S, n=12) and normal group(group N, n=12) according to preoperative results of transthoracic echocardiography. Cesarean section was performed with continuous epidural anesthesia.Basic information and clinical outcome indicators were recorded separately. Hemodynamic parameters were monitored with Mostcare. Arterial pressure, heart rate, systemic vascular resistance index(SVRI), cardiac cycle efficiency(CCE), cardiac index(CI), dp/dtmax, pulse pressure variation and stroke volume index were recorded before anesthesia(T1), 3min after anesthesia(T2), before delivery(T3), 5 min after delivery(T4) and end of the operation(T5). Results: NYHA grading result in the group S was inferior to that in the group N(P<0.01). Systolic pressure in group S were significantly lower than those in group N at T1 and T2(both P<0.05);Dicrotic pressure in group S were significantly lower than those in group N at T1 and T2(both P<0.05);Heart rate in group S were significantly higher than those in group N at T4(P<0.05);CCE in group S were significantly lower than those in group N at T2 and T4(both P<0.05);Dp/dtmax in group S were significantly lower than those in group N at T1 and T2(both P<0.05);PPV in group S were significantly higher than those in group N at T5(P<0.05);Total hospitalization time of group S were significantly longer than group N(P<0.01). Conclusions: Pressurerecording analytical method can reveal the hemodynamic changes of pregnant women with or without severe pulmonary hypertension in caesarean section precisely and objectively. More sophisticated management during perioperative period are required for pregnant women with severe pulmonary hypertension with their less stable hemodynamic characteristics and poorer a

关 键 词：妊娠合并肺动脉高压 压力记录分析法 血流动力学 

分 类 号：R54[医药卫生—心血管疾病]