摘要
目的探讨人体感觉阻滞平面上升速率,对剖宫产术腰硬联合麻醉(CSEA)后低血压的预测价值。方法选择2019年1月至12月,于成都医学院第二附属医院•核工业四一六医院进行择期剖宫产术分娩,美国麻醉医师协会(ASA)分级为Ⅰ~Ⅱ级的单胎妊娠产妇80例为研究对象。根据产妇是否发生CSEA后低血压,将其分为低血压组(n=36)与对照组(n=44)。对2组产妇采取L3~4腰椎间隙CSEA,于蛛网膜下腔15 s内推注0.5%重比重布比卡因2.4 mL。2组产妇CSEA注射药物后15 min内,每1 min监测1次生命体征、感觉阻滞平面及其时间,并采用成组t检验或Wilcoxon秩和检验对其进行统计学比较。绘制受试者工作特征(ROC)曲线,分析人体感觉阻滞平面上升速率(人体感觉阻滞平面达T8、T6的时间),对于预测剖宫产术分娩产妇发生CSEA后低血压的价值,并确定其最佳临界值。本研究方案经病例收集医院伦理委员会批准[审批文号:2018年审(030)号],并与受试者签署临床研究知情同意书。2组产妇年龄、身高、孕龄、人体质量指数(BMI)、脑脊液流出时间、CSEA注射药物后至恢复仰卧位时间、CSEA注射药物前输液量,术中输液量、失血量及尿量等一般临床资料比较,差异均无统计学意义(P>0.05)。结果①低血压组产妇发生CSEA后低血压时,人体感觉阻滞平面为T5(T6~T4),发生CSEA后低血压的时间为CSEA注射药物后8 min(7~8 min),均显著低于组内人体感觉最高阻滞平面T4(T4~T3)和短于组内人体感觉达最高阻滞平面的时间CSEA注射药物后10 min(9~11 min),并且差异均有统计学意义(Z=-5.030、P<0.001,Z=-6.732、P<0.001)。低血压组产妇人体感觉阻滞平面达T8、T6与最高阻滞平面的时间分别为CSEA注射药物后3 min(3~4 min)、6 min(5~7 min)与10 min(9~11 min),均显著短于对照组的CSEA注射药物后5 min(5~6 min)、8 min(7~9 min)与11 min(10~12 min),而低血压组人体感觉最高阻滞平面T4(T4~T3)显著�
Objective To explore prediction value of rising rate of sensory level on combined spinal-epidural anesthesia(CSEA)induced hypotension during cesarean section.Methods A total of 80 singleton pregnant women with American Society of Anesthesiologists(ASA)gradeⅠ-Ⅱwho underwent elective cesarean section in the Second Affiliated Hospital of Chengdu Medical College,China National Nuclear Corporation 416 Hospital from January to December 2019,were selected as research subjects.All pregnant women were divided into hypotension group(n=36)and control group(n=44),according to whether development of CSEA induced hypotension or not.All of them underwent CSEA in L3-4 intervertebral space and were injected with 2.4 mL of 0.5%hyperbaric bupivacaine into subarachnoid space(injection time was 15 s).The vital signs,sensory level and time of pregnant women in two groups were detected once per minute within 15 minutes after CSEA,and above indicators were statistically compared by independent-samples t test or Wilcoxon rank-sum test.The receiver operating characteristic(ROC)curve was drawn to analyze predictive value of rising rate of sensory level(at the time of sensory level reaching T8 and T6)on CSEA induced hypotension in pregnant women with elective cesarean section,and to determine the optimal cut-off value.This research was approved by the Ethics Committee of the Second Affiliated Hospital of Chengdu Medical College&Nuclear Industry 416 Hospital[Approval No.2018(030)],and informed consent forms for clinical research was signed with each research subject.There were no significant differences in age,height,gestational age,body mass index(BMI),cerebrospinal fluid outflow time,the time from CSEA to supine position,infusion volume before CSEA,intraoperative infusion volume,blood loss volume and urine volume between two groups(P>0.05).Results①When CSEA induced hypotension occurred in hypotension group,sensory level was T5(T6-T4),and the time of occurrence of CSEA induced hypotension was 8 min(7-8 min)after CSEA injection,which w
作者
田颖
张科
李羽
Tian Ying;Zhang Ke;Li Yu(Anesthesia&Operation Center,West China Hospital of Sichuan University,Chengdu 610041,Sichuan Province,China;Department of Anesthesiology,the Second Affiliated Hospital of Chengdu Medical College,China National Nuclear Corporation 416 Hospital,Chengdu 610051,Sichuan Province,China)
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2021年第2期159-165,共7页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
基金
四川省科技厅重点研发项目(2018SZ0217)。
关键词
麻醉
产科
感觉阻滞平面
麻醉
脊椎
剖宫产术
低血压
产妇
Anesthesia,obstetrical
Sensory block plane
Anesthesia,spinal
Cesarean section
Hypotension
Puerpera
