摘要
目的评价麻黄碱预处理对腰麻重比重液剖宫产产妇麻醉中血流动力学的影响。方法拟行剖宫产手术的患者60例,美国麻醉医师协会麻醉风险评分（ASA）Ⅰ~Ⅱ级,通过随机数字表法将患者分为A组（麻黄碱预处理组）、B组（对照组）各30例,应用常规多功能监护仪和美国Bio Z公司无创血流动力学监测仪进行监测,记录患者翻身左侧卧位前1 min（T0）,给予麻醉药即刻（T1）,给药后2 min（T2）,给药后5 min（T3）,给药后10 min（T4）的血压（BP）、心率（HR）、脉搏氧饱和度（Sp O2）、心输出量（CO）、外周血管阻力指数（SVRI）、加速指数（ACI）、胸腔液体量（TFC）以及左室做功指数（LCWI）。结果 A组患者麻醉后T2时点的SVR较T0降低[（908.3±198.5）dyne·s/cm^5vs.（1 078.8±227.6）dyne·s/cm^5,P〈0.01],CO升高[（6.3±0.8）L/min vs.（5.8±0.8）L/min,P〈0.01]。B组在T2时点MAP[（67.3±14.2）mm Hg]、SVR[（770.4±132.9）dyne·s/cm^5]、CO[（5.1±0.7）L/min]均低于同组T0时点和A组同时点的指标（P均〈0.01）。B组23例T2时点出现明显血流动力学变化,静脉给予麻黄碱处理。T3时点的MAP上升至（78.1±10.2）mm Hg,SVR上升至（879.3±146.2）dyne·s/cm^5,CO上升至（6.4±0.7）L/min;但T3时点的SVR仍低于T0时点[（879.3±146.2）dyne·s/cm^5vs.（1 065.4±225.8）dyne·s/cm^5,P〈0.01],T3时点的CO高于T0时点[（6.4±0.7）L/min vs.（5.8±0.5）L/min,P〈0.01）。结论应用Bio Z监测仪可以全面了解围术期产妇的血流动力学变化,麻黄碱预处理可以保持剖宫产手术腰麻围麻醉期产妇的血流动力学平稳。
Objective To study the influence of ephedrine pretreatment on maternal hemodynamics who received cesarean section under hyperbaric spinal anesthesia with thoracic impedance. Methods Sixty patients who were ASA I-II undergoing cesarean section were randomly divided into group A（the ephedrine pretreatment）, group B（control）, 30 patients were in each group. Conventional multi-function monitors and the United States Bio Z company noninvasive hemodynamic monitoring instrument were used to monitor hemodynamic changes. Blood pressure（BP）, heart rate（HR）, pulse oxygen saturation（SpO2）, cardiac output（CO）, systemic vascular resistance index（SVRI）, acceleration index（ACI）, thoracic fluid amount（TFC） and left ventricular work index（LCWI） were recorded at 1 min before turning left lateral decubitus（T0）, the time of administration（T1）, 2 min（T2）, 5 min（T3）, and 10 min after administration（T4）. Results The SVR decreased from（1 078.8±227.6） dyne· s/cm^5to（908.3±198.5） dyne· s/cm^5 and CO increased from（5.8±0.8） L/min to（6.3±0.8） L/min（P〈 0.01） in group A after ephedrine administration.The MAP（67.3±14.2）mm Hg,SVR（770.4±132.9）dyne·s/cm^5 and CO（5.1 ± 0.7）L/min on T2 in group B were lower than T0 and group A at the same time（P〈 0.01）. The MAP（78.1±10.2）mm Hg,SVR（879.3±146.2） dyne· s/cm^5 and CO（6.4±0.7） L/min increased after ephedrine treatment, but the SVR still lower than T0（1 065.4±225.8） dyne· s/cm^5 and the CO were higher than T0（5.8±0.5） L/min（P〈 0.01）. Conclusion The Bio Z monitor can help to know more about the hemodynamic changes. Ephedrine pretreatment has no significant influence on hemodynamics of maternal who received cesarean section.
出处
《北京医学》
CAS
2015年第12期1161-1163,共3页
Beijing Medical Journal
关键词
胸阻抗法
剖宫产
腰麻
血流动力学
麻黄碱
Thoracic impedance method
Cesarean section
Spinal anesthesia
Hemodynamic
Ephedrine
