连续无创血压监测系统预测腰硬联合麻醉下择期剖宫产术低血压的研究  

Role of continuous non-invasive blood pressure monitoring system in the prediction of hypotension in elective cesarean section under combined spinal-epidural anesthesia

作　　者：黄锡强[1] 袁炳林 凌泉[1] HuangXiqiang;Yuan Binglin;LingQuan(Department of Anesthesiology,Zhongshan People's Hospital,Zhongshan Guangdong 528400,P.R.China)

机构地区：[1]中山市人民医院麻醉科,广东中山528400

出　　处：《中国计划生育和妇产科》2022年第11期35-39,共5页Chinese Journal of Family Planning & Gynecotokology

基　　金：中山市卫生健康局科研项目(项目编号:2020J042)。

摘　　要：目的探讨连续无创血压监测系统对腰硬联合麻醉下择期剖宫产术低血压的预测效果。方法选择2020年5~9月中山市人民医院75例连续无创血压监测系统配合腰硬联合麻醉行择期剖宫产产妇作为研究对象,根据是否出现低血压事件分成Non-H组(未出现低血压,n=37)和H组(出现低血压,n=38)。比较两组产妇术中收缩压、舒张压、平均动脉压、麻醉效果、手术时间、最高阻滞平面、术中输液量、术中出血量、多巴胺使用量、心率、心输出量、外周血管阻力、基础灌注指数;比较两组产妇麻醉效果及手术效果;并基于连续无创血压监测系统构建回归模型,分析该模型对择期剖宫产术中低血压的预测价值。结果①两组产妇T1收缩压、舒张压、平均动脉压差异无统计学意义(P>0.05);H组T2收缩压、舒张压、平均动脉压低于Non-H组(P<0.05);②两组产妇麻醉效果、术中出血量、术中尿量、T1心率、T1心输出量、T2心输出量、T1外周血管阻力、T1基础灌注指数差异无统计学意义(P>0.05);H组产妇手术时间、多巴胺使用量多于Non-H组(P<0.01);H组产妇T2心率、T2基础灌注指数高于Non-H组(P<0.05);H组产妇最高阻滞平面、外周血管阻力低于Non-H组(P<0.01);③T2收缩压、T2平均动脉压为择期破剖宫产术中低血压的影响因素,且为保护因素;④Logistic逐步回归模型预测剖宫产术中低血压的曲线下面积值(AUC)为0.986(95%CI:0.926-1.000),约登指数0.894,以0.596为临界值,其预测剖宫产术中低血压的敏感度、特异度为92.11%、97.30%结论基于连续无创血压监测系统构建的Logistic逐步回归模型对择期剖宫产术低血压有优势预测效能,值得临床重视。Objective To investigate the predictive effect of continuous non-invasive blood pressure monitoring system on hypotension in elective cesarean section under combined spinal-epidural anesthesia.Methods From May to September 2020,selected 75 cases of Zhongshan People’s Hospital continuous non-invasive blood pressure monitoring system with combined spinal-epidural anesthesia for elective cesarean section as the research object.They were divided into Non-H group(no hypotension, n=37) and H group(hypotension, n=38) according to the occurrence of hypotension.The systolic blood pressure, diastolic blood pressure, mean arterial pressure, anesthetic effect, operation time, the highest level of block, intraoperative infusion volume, intraoperative blood loss, dopamine usage, heart rate, cardiac output, peripheral vascular resistance and basic perfusion index were compared between the two groups.The anesthetic effect and surgical effect of the two groups were compared.A regression model was constructed based on the continuous non-invasive blood pressure monitoring system, and its predictive value for hypotension during elective cesarean section was analyzed.Results(1) T here were no statistically significant differences in systolic blood pressure, diastolic blood pressure, and mean arterial pressure at T1 between the two groups(P>0.05).T2 systolic blood pressure, diastolic blood pressure and mean arterial pressure in H group were lower than those in the Non-H group(P<0.05).(2) There were no statistically significant differences in anesthetic effect, intraoperative blood loss, intraoperative urine volume, T1 heart rate, T1 cardiac output, T2 cardiac output, T1 peripheral vascular resistance, and T1 basic perfusion index between the two groups(P>0.05).The operation time and dosage of dopamine of H group were more than those of the Non-H group(P<0.01).Heart rate and T2 basic perfusion index at T2 in H group were higher than those in Non-H group(P<0.05).The highest block plane and peripheral vascular resistance in H group wer

关 键 词：连续无创血压监测系统 腰硬联合麻醉 剖宫产 低血压 

分 类 号：R714.2[医药卫生—妇产科学]