摘要
目的 探讨目标导向液体治疗对子痫前期孕产妇行腰麻剖宫产术中低血压发生率的影响。方法 共募集行择期剖宫产术的晚发型稳定期子痫前期孕妇26例（子痫前期组）及正常孕妇26名（正常组）。选用小剂量布比卡因（7.5 mg）进行腰硬联合麻醉,在腰麻给药同时采用Li DCOrapid系统提供的容量反应性参数（ΔSV）进行目标导向液体治疗,使每搏量最优化。观察两组间低血压发生率、血管活性药物用量及血流动力学变化趋势。结果 子痫前期组需要第二次容量冲击的比例高于对照组（54%vs.32%）。与对照组比较,子痫前期组低血压（15.4%vs.19.2%,P=0.714）、苯肾上腺素用量[（0～13.5）μg vs.（0～23.1）μg,P=0.771]等不良事件发生率的差异无统计学意义。与基础值比较,两次容量冲击试验均可显著增加孕妇的心输出量和每搏量（P〈0.05）。结论 目标导向液体治疗后,晚发型稳定期子痫前期孕妇与正常孕妇比较腰麻后低血压发生率没有显著区别。
Objective To investigate the incidence of post-spinal hypotension between preeclampsia parturient and normal parturient following goal-directed fluid therapy.Methods Twenty six stable preeclampsia parturients and 26 normal parturients scheduled for elective cesarean section were recruited.Standard combined spinal epidural anesthesia was performed with low dose bupivacaine（7.5 mg）.At the timepoint of spinal injection,goal-directed fluid therapy was employed to optimize the stroke volume via the ΔSV provided by Li DCOrapid system.The hemodynamic changes and the adverse events including maternal hypotension and vasopressor dose were recorded and analyzed.Results The ratio of parturient who needed second fluid challenge was higher in the preeclampsia group compared with the healthy controls（54% vs.32%）.Compared with normal control,there were no significant differences in the hypotension incidence（15.4%vs.19.2%,P = 0.714） and vasopressors used（P = 0.771） in preeclampsia parturient and healthy parturient.Compared with the baseline,the cardiac output and stroke volume in both groups were significantly increased following both fluid challenges（P〈 0.05）.Conclusion There is no significant difference in post-spinal hypotension incidence between stable preeclampsia parturient and healthy parturient following goal-directed fluid therapy.
出处
《北京医学》
CAS
2015年第8期731-735,共5页
Beijing Medical Journal
基金
北京市优秀人才培养资助(2014000020124G160)
关键词
腰硬联合麻醉
子痫前期
低血压
目标导向液体治疗
Combined spinal epidural anesthesia
Pre-eclampsia
Hypotension
Goal-directed fluid therapy
