连续无创血压监测预防腰硬联合麻醉后低血压对剖宫产术母婴结局的影响:一项单中心、前瞻性、随机对照试验  

The effects of continuous noninvasive arterial pressure monitoring on preventing maternal and neonatal outcomes from hypotension after combined spinal-epidural anesthesia in cesarean delivery:a single-center,prospective,randomized controlled trial

作　　者：吴惠言 李集源 陈添辉 梁颖心 李曙佳 张奕文 WU Huiyan;LI Jiyuan;CHEN Tianhui;LIANG Yingxin;LI Shujia;ZHANG Yiwen(Department of Anesthesiology,Shunde Hospital of Southern Medical University,The First People's Hospital of Shunde,Foshan 528300,China)

机构地区：[1]南方医科大学顺德医院(佛山市顺德区第一人民医院)麻醉科,广东佛山528300

出　　处：《分子影像学杂志》2024年第12期1314-1321,共8页Journal of Molecular Imaging

基　　金：广东省科学技术厅国际和港澳台“海外名师”人才项目(粤科智字2022.232号);广东省基础与应用基础研究基金联合基金(2023A1515141042);佛山市自筹经费类科技创新项目(2320001006966)。

摘　　要：目的探讨与传统间断无创袖带动脉压监测(NCAP)相比,连续无创动脉血压监测(CNAP)对腰硬联合麻醉(CSEA)下剖宫产母婴结局的影响。方法采用前瞻性、随机对照临床试验方法,选取2024年1~6月在南方医科大学顺德医院开展CSEA下行择期剖宫产手术产妇,根据纳入及排除标准,共入选284例产妇,随机分机两组,142例/组,由于体动、寒战或其他原因14例产妇被剔除研究,最终NCAP组139例、CNAP组131例产妇进行分析。NCAP组:手术过程中使用间断袖带监测血压,每隔3 min测量1次血压;CNAP组:使用CNAP连续监测血压。当收缩压低于基础值的80%或平均动脉压低于65 mmHg,立即通过静脉注射去甲肾上腺素6~10μg纠正低血压,并根据患者的血压情况适时重复给药。记录各时间点血流动力学变化、去甲肾上腺素的使用情况、产妇不良反应、胎儿脐动脉血流指标和新生儿脐动脉血气分析结果等。结果与NCAP组相比,CNAP组能更早发现低血压(P=0.008),低血压检出率更高(P=0.024);因CNAP组能更早更频繁地发现低血压,并及时阻止血压进一步下降,产妇严重低血压发生率更低(P=0.005),需要使用去甲肾上腺素的中位剂量(P=0.014)和使用频率(P=0.012)更高。在麻醉后4~28 min内,CNAP组的收缩压始终高于NCAP组(P<0.05);CNAP组在麻醉后的多个时间点(第7、10、13、16、19、22、25分钟)的低血压发生率低于NCAP组(P<0.05);与NCAP组相比,CNAP组产妇恶心、呕吐发生率降低(P=0.017);胎儿脐动脉收缩期峰值流速与舒张末期流速比值、脐动脉阻力指数、脐动脉搏动指数均较麻醉前升高,且麻醉后3 min NCAP组比CNAP组升高更明显(P<0.001),而对于平均动脉压低于60 mmHg的产妇,NCAP组的新生儿脐动脉血气pH低于CNAP组(P=0.026);麻醉后6 min的胎儿脐动脉收缩期峰值流速与舒张末期流速比值、脐动脉阻力指数、搏动指数、新生儿Apgar评分及脐动脉血pH值、BE、PaO_(2)和PaObjective To assess the impact of continuous noninvasive arterial blood pressure monitoring(CNAP)on maternal and neonatal outcomes during cesarean section under combined spinal-epidural anesthesia(CSEA),as compared to the conventional noninvasive cuff arterial pressure(NCAP).Methods In a prospective,randomized controlled clinical trial conducted from January to June 2024 at Shunde Hospital of Southern Medical University,we enrolled 284 eligible parturients scheduled for elective cesarean delivery under CSEA.Participants were randomly assigned to two groups,with 142 parturients in each.Due to factors such as movement,shivering,or other reasons,14 parturients were excluded from the study.The final analysis included 139 parturients in the NCAP group and 131 in the CNAP group.NCAP group,blood pressure was monitored using an intermittent cuff during the procedure,with measurements taken at 3-minute intervals;CNAP group:blood pressure was continuously monitored using CNAP.When systolic blood pressure(SBP)fell below 80%of the baseline value or mean arterial pressure(MAP)dropped below 65 mmHg,hypotension was promptly treated with an intravenous bolus of norepinephrine at a dose of 6-10μg,with additional doses administered as necessary based on the patient's blood pressure response.At each time point,we recorded hemodynamic changes,the requirement for norepinephrine administration,maternal adverse effects,fetal umbilical artery flow indices,and the results of neonatal umbilical artery blood gas analysis.Results Compared with the NCAP group,the CNAP group detected hypotension at an earlier stage(P=0.008)and exhibited a higher rate of hypotension detection(P=0.024).Owing to the CNAP group's earlier and more frequent detection of hypotension,which allowed for timely intervention to prevent further blood pressure drops,the incidence of severe maternal hypotension was significantly reduced(P=0.005).Additionally,the median dose of norepinephrine required(P=0.014)and the frequency of its administration(P=0.012)were higher in th

关 键 词：连续无创动脉血压监测 剖宫产 腰硬联合麻醉 低血压 新生儿 

分 类 号：R614[医药卫生—麻醉学]