国际麻醉学与复苏杂志   2019, Issue (6): 0-0
    
不同液体管理方案对蛛网膜下腔-硬膜外联合麻醉下剖宫产胎儿的影响
段庆芳, 肖玮, 姚东旭, 郎宇, 尹橙, 王天龙1()
1.首都医科大学宣武医院麻醉科
Effects of different fluid therapy strategies on fetuses during caesarean section under combined spinal-epidural anesthesia
 全文:
摘要:

目的 探讨不同液体管理方案对蛛网膜下腔-硬膜外联合麻醉下剖宫产手术中胎儿代谢的影响,寻找更加有利于母婴的液体管理方案。 方法 选择ASA分级Ⅱ级,择期行剖宫产手术的产妇100例,采用随机数字表法分为对照组(C组)和目标导向液体治疗组(G组)。两组产妇入室后均给予乳酸钠林格液10 ml/kg,后以2 ml·kg-1·h-1持续输注。当血压低于基础值的80%或SBP低于90 mmHg(1 mmHg=0.133 kPa)时,C组应用血管活性药物处理,G组应用LiDCOrapid指套、袖带建立的无创血压监测(continuous noninvasive arterial blood pressure measurement, CNAP)进行液体冲击试验指导补液。胎儿娩出后,记录新生儿Apgar评分及脐动脉血、脐静脉血血气分析值。 结果 C组1例新生儿Apgar评分为9分,1例新生儿为8分,余新生儿Apgar评分均为10分;G组新生儿Apgar评分均为10分。C组脐静脉血pH值、氧饱和度(oxygen saturation, SO2)低于G组,而乳酸(lactate, Lac)水平和二氧化碳分压(partial pressure of carbon dioxide, PCO2)高于G组,差异有统计学意义(P<0.05)。C组脐动脉血SO2低于G组(P<0.05),其余差异无统计学意义(P>0.05)。 结论 目标导向液体治疗能改善剖宫产过程中胎儿氧供及代谢。

关键词: 目标导向液体管理; 剖宫产; 蛛网膜下腔-硬膜外联合麻醉
Abstract:

Objective To investigate the effects of different fluid therapy strategies on fetuses during caesarean section under combined spinal-epidural anesthesia. Methods A total of 100 pregnant women [American Society of Anesthesiologists (ASA)grade Ⅱ] who were scheduled to undergo caesarean were enrolled and randomly divided into to a control group (group C) and a goal directed fluid therapy (GDFT) group (group G). Both groups were given 10 ml/kg Lactated Ringer′s at a bolus and maintained at the rate of 2 ml·kg-1·h-1. Group C were treated with vasopressors when the blood pressure was 80% lower than the baseline or the systolic blood pressure (SBP) was lower than 90 mmHg (1 mmHg=0.133 kPa). Meanwhile, group G was treated with GDFT guided by LiDCOrapid-CNAP (continuous noninvasive arterial blood pressure measurement). After delivery, neonate Apgar scores and blood gas analysis results of the umbilical artery and vein were recorded. Results The Apgar scores of the neonates in group C were 10, expect 1 case of 9 score and 1 case of 8 score. All the neonates in group G had 10 Apgar scores. Compared with group C, group G presented remarkable increases in umbilical vein pH value and pulse oxygen saturation (SpO2) and umbilical arterial oxygen saturation (SO2) as well as marked decreases in lactate (Lac) levels and partial pressure of carbon dioxide(PCO2)(P<0.05).  Conclusions GDFT guided by LiDCOrapid-CNAP can improve oxygen and metabolism to fetuses during caesarean section.

Key words: Goal-directed fluid therapy; Caesarean section; Combined spinal-epidural anesthesia