摘要
目的探讨新型子宫托架对蛛网膜下腔麻醉剖宫产产妇血流动力学和新生儿的影响。方法择期行椎管内麻醉剖宫产产妇60例,随机分为子宫托架组和体位改变组各30例。麻醉成功后取平卧,子宫托架组将新型子宫托架安置于手术床两侧,并将两侧托球置于产妇子宫下缘,向上托起子宫后固定托球;体位改变组将手术床左倾30°。记录产妇麻醉前取仰卧位时(T1)、麻醉及干预后(T2)、麻醉后5 min(T3)、胎儿娩出时(T4)和手术结束时(T5)收缩压和心率。记录2组T1~T3时下腔静脉呼气末最大内径(maximum end-expiratory diameter of inferior vena cava,IVCmax)和吸气末最小内径(minimum diameter of inspiratory end of inferior vena cava,IVCmin)及下腔静脉塌陷指数(collapsible index of vena cava,cIVC),观察2组术中低血压和恶心、呕吐发生率。记录胎儿娩出后1、5 min时Apgar评分及新生儿脐带血血气指标。结果2组各时间点心率比较差异无统计学意义(P>0.05);T2、T3时,子宫托架组收缩压[(112.6±9.7)、(104.8±11.2)mm Hg]高于体位改变组[(104.4±3.6)、(84.7±13.5)mm Hg](P<0.05),IVCmax[(15.0±2.5)、(14.5±2.6)mm]和IVCmin[(10.1±2.3)、(9.9±2.1)mm]大于体位改变组[(13.6±2.5)、(13.5±1.7)mm,(8.5±1.6)、(8.4±1.4)mm],cIVC[(32.4±5.9)%、(31.1±8.4)%]小于体位改变组[(38.0±10.1)%、(37.9±9.1)%](P<0.05);T2、T3时,2组IVCmax和IVCmin均大于T1时(P<0.05),子宫托架组cIVC小于T1时(P<0.05),体位改变组cIVC与T1时比较差异无统计学意义(P>0.05);子宫托架组新生儿脐动脉和静脉血pH、p(O2)高于体位改变组(P<0.05),碱剩余负值小于体位改变组(P<0.05),新生儿1、5 min时Apgar评分[(8.3±0.2)、(9.8±0.1)分]均大于体位改变组[(7.2±0.3)、(8.7±0.5)分](P<0.05),低血压发生率(10.0%)和恶心、呕吐发生率(0)低于体位改变组(56.7%、36.7%)(P<0.05)。结论应用新型子宫托架预防产妇蛛网膜下腔麻醉剖宫产术低血压效果确切,有助于维持产妇血流动力学稳定,提高新生儿Apgar评分。
Objective investigate the effect of a new type of uterine bracket on parturient hemodynamics and neonate during subarachnoid anesthesia for cesarean delivery.Methods Sixty pregnant women scheduled for elective cesarean delivery under subarachnoid anesthesia were randomly divided into uterine bracket group(n=30)and postural change group(n=30).After successful subarachnoid anesthesia,the parturient was immediately put into a supine position,a uterine bracket was placed in uterine bracket group,while the operating bed was tilted 30 degrees to the left in postural change group.The systolic blood pressure and heart rate were recorded in supine position before anesthesia(T1),after anesthesia and intervention(T2),5 min after anesthesia(T3),at the time of delivery(T4)and at the end of operation(T5).The maximum end-expiratory diameter(IVCmax)and minimum end-inspiratory diameter(IVCmin)of the inferior vena cava(IVC)in two groups were recorded at T1-3,and the collapsible index of vena cava(cIVC)was calculated.The occurrences of adverse reactions including hypotension and nausea/vomiting were observed,and the Apgar score in 1 and 5 min after delivery and umbilical vein blood gas indexes were recorded.Results There was no significant difference in heart rate between two groups at each point(P>0.05).The systolic blood pressures at T2 and T3 were higher in uterine bracket group((112.6±9.7),(104.8±11.2)mm Hg)than those in postural change group((104.4±3.6),(84.7±13.5)mm Hg)(P<0.05),IVCmax and IVCmin at T2 and T3 were higher in uterine bracket group(IVCmax:(15.0±2.5),(14.5±2.6)mm;IVCmin:(10.1±2.3),(9.9±2.1)mm)than those in postural change group(IVCmax:(13.6±2.5),(13.5±1.7)mm;IVCmin:(8.5±1.6),(8.4±1.4)mm)(P<0.05),and cIVCs were lower in uterine bracket group((10.1±2.3)%,(9.9±2.1)%)than those in postural change group((38.0±10.1)%,(37.9±9.1)%)(P<0.05).IVCmax and IVCmin at T2 and T3 were higher than at T1 in both groups(P<0.05).cIVC was lower at T2 and T3 than that at T1 in uterine bracket group(P<0.05),and showed no significant difference in postural change group(P>0.05).The umbilical artery and venous blood gas pH and p(O2)values were higher in uterine bracket group than those in postural change group,and the negative values of base excess were lower in uterine bracket group than those in postural change group(P<0.05).The neonatal Apgar scores in 1 and 5 min after delivery were greater in uterine bracket group(8.3±0.2,9.8±0.1)than those in postural change group(7.2±0.3,8.7±0.5)(P<0.05).The incidences of hypotension and nausea/vomiting were lower in uterine bracket group(10.0%,0)than those in postural change group(56.7%,36.7%)(P<0.05).Conclusion The new type of uterine bracket can prevent hypotension in cesarean delivery under subarachnoid anesthesia,maintain the stability of parturient hemodynamics,and improve the Apgar score.
作者
崔明珠
牛鹏飞
阮孝国
孟凡民
张加强
CUI Mingzhu;NIU Pengfei;RUAN Xiaoguo;MENG Fanmin;ZHANG Jiaqiang(Department of Anesthesiology and Perioperative Surgery,Henan Provincial People's Hospital,Henan University People's Hospital,Zhengzhou 450003,China)
出处
《中华实用诊断与治疗杂志》
2020年第6期588-591,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省科技厅产学研项目(182107000025)。
关键词
剖宫产
低血压
椎管内麻醉
APGAR评分
caesarean
hypotension
subarachnoid anesthesia
neonatal Apgar score
