中华产科急救电子杂志
中華產科急救電子雜誌
중화산과급구전자잡지
Chinese Journal of Obstetric Emergency
2014年
1期
64-68
,共5页
陈郡兴%蓝绮云%靳三庆%詹鸿
陳郡興%藍綺雲%靳三慶%詹鴻
진군흥%람기운%근삼경%첨홍
剖宫产术%麻醉,产科%麻醉药,联用%低血压%防治
剖宮產術%痳醉,產科%痳醉藥,聯用%低血壓%防治
부궁산술%마취,산과%마취약,련용%저혈압%방치
Cesarean section%Anesthesia,obstetrical%Anesthetics,combined%Hypotension%Prevention
目的:对择期剖宫产患者腰硬联合麻醉( combined spinal epidural anesthesia ,CSEA)中出现的低血压进行分析,确定其中最主要的影响因素并由此探讨解决方案。方法收集2010年6月至2011年5月在广州医科大学附属第三医院行择期子宫下段剖宫产手术,按美国麻醉医师协会(ASA)分级Ⅰ-Ⅱ级、在CSEA下的单胎妊娠患者240例,采用多元线性回归方法进行分析,以低血压的发生例次作为因变量,以容量控制、升压药(苯肾上腺素)的使用方式、麻醉药物种类、测量血压的间隔时间以及产妇的年龄、身高、体重、体重指数,卡前列素氨丁三醇注射液的总量、苯肾上腺素的持续剂量与苯肾上腺素的总量、术中硬膜外用药量、麻醉前液体入量、液体总入量、术中出血量、手术时间、术前产妇痛觉阻滞平面到达胸6时的触觉阻滞平面、压觉阻滞平面等共18项为自变量。按苯肾上腺素的3种使用方式重新分为3组:不预防性使用组,预防性使用组,预防性使用+持续使用组。以单因素方差分析对各组产妇低血压发生例次及新生儿出生时脐静脉血 pH值、碱过剩( base excess , BE)值与1 min Apgar评分进行比较。结果得到多元线性回归方程:低血压发生例次=0.218-34.206×苯肾上腺素的持续剂量+1.096×苯肾上腺素总量-0.214×麻醉用药种类。不预防性使用组,预防性使用组,预防性使用+持续使用组,3组中低血压发生例次分别为3.53±2.02,2.76±1.81,0.88±1.17;预防性使用+持续使用组患者的低血压发生例次均明显低于另外两组( P<0.01)各组新生儿的pH值、BE值、1 min Apgar评分均无统计学差异( P>0.05)。在患者麻醉注药时,静脉注射苯肾上腺素1μg/kg、并继以0.25~0.35μg/(kg· min)的剂量维持,有助于保持患者血压稳定。结论择期剖宫产产妇腰硬联合麻醉后低血压最主要的影响因素是苯肾上腺素的持续剂量。
目的:對擇期剖宮產患者腰硬聯閤痳醉( combined spinal epidural anesthesia ,CSEA)中齣現的低血壓進行分析,確定其中最主要的影響因素併由此探討解決方案。方法收集2010年6月至2011年5月在廣州醫科大學附屬第三醫院行擇期子宮下段剖宮產手術,按美國痳醉醫師協會(ASA)分級Ⅰ-Ⅱ級、在CSEA下的單胎妊娠患者240例,採用多元線性迴歸方法進行分析,以低血壓的髮生例次作為因變量,以容量控製、升壓藥(苯腎上腺素)的使用方式、痳醉藥物種類、測量血壓的間隔時間以及產婦的年齡、身高、體重、體重指數,卡前列素氨丁三醇註射液的總量、苯腎上腺素的持續劑量與苯腎上腺素的總量、術中硬膜外用藥量、痳醉前液體入量、液體總入量、術中齣血量、手術時間、術前產婦痛覺阻滯平麵到達胸6時的觸覺阻滯平麵、壓覺阻滯平麵等共18項為自變量。按苯腎上腺素的3種使用方式重新分為3組:不預防性使用組,預防性使用組,預防性使用+持續使用組。以單因素方差分析對各組產婦低血壓髮生例次及新生兒齣生時臍靜脈血 pH值、堿過剩( base excess , BE)值與1 min Apgar評分進行比較。結果得到多元線性迴歸方程:低血壓髮生例次=0.218-34.206×苯腎上腺素的持續劑量+1.096×苯腎上腺素總量-0.214×痳醉用藥種類。不預防性使用組,預防性使用組,預防性使用+持續使用組,3組中低血壓髮生例次分彆為3.53±2.02,2.76±1.81,0.88±1.17;預防性使用+持續使用組患者的低血壓髮生例次均明顯低于另外兩組( P<0.01)各組新生兒的pH值、BE值、1 min Apgar評分均無統計學差異( P>0.05)。在患者痳醉註藥時,靜脈註射苯腎上腺素1μg/kg、併繼以0.25~0.35μg/(kg· min)的劑量維持,有助于保持患者血壓穩定。結論擇期剖宮產產婦腰硬聯閤痳醉後低血壓最主要的影響因素是苯腎上腺素的持續劑量。
목적:대택기부궁산환자요경연합마취( combined spinal epidural anesthesia ,CSEA)중출현적저혈압진행분석,학정기중최주요적영향인소병유차탐토해결방안。방법수집2010년6월지2011년5월재엄주의과대학부속제삼의원행택기자궁하단부궁산수술,안미국마취의사협회(ASA)분급Ⅰ-Ⅱ급、재CSEA하적단태임신환자240례,채용다원선성회귀방법진행분석,이저혈압적발생례차작위인변량,이용량공제、승압약(분신상선소)적사용방식、마취약물충류、측량혈압적간격시간이급산부적년령、신고、체중、체중지수,잡전렬소안정삼순주사액적총량、분신상선소적지속제량여분신상선소적총량、술중경막외용약량、마취전액체입량、액체총입량、술중출혈량、수술시간、술전산부통각조체평면도체흉6시적촉각조체평면、압각조체평면등공18항위자변량。안분신상선소적3충사용방식중신분위3조:불예방성사용조,예방성사용조,예방성사용+지속사용조。이단인소방차분석대각조산부저혈압발생례차급신생인출생시제정맥혈 pH치、감과잉( base excess , BE)치여1 min Apgar평분진행비교。결과득도다원선성회귀방정:저혈압발생례차=0.218-34.206×분신상선소적지속제량+1.096×분신상선소총량-0.214×마취용약충류。불예방성사용조,예방성사용조,예방성사용+지속사용조,3조중저혈압발생례차분별위3.53±2.02,2.76±1.81,0.88±1.17;예방성사용+지속사용조환자적저혈압발생례차균명현저우령외량조( P<0.01)각조신생인적pH치、BE치、1 min Apgar평분균무통계학차이( P>0.05)。재환자마취주약시,정맥주사분신상선소1μg/kg、병계이0.25~0.35μg/(kg· min)적제량유지,유조우보지환자혈압은정。결론택기부궁산산부요경연합마취후저혈압최주요적영향인소시분신상선소적지속제량。
Objective To analyze the factors of maternal hypotension undergoing elective cesarean section with combined spinal epidural anesthesia ( CSEA ) , and to investigate the prevention method . Methods A retrospective study was conducted in 240 pregnant women undergoing ASA Ⅰ-Ⅱ elective cesarean section with CSEA , who were admitted to The Third Affiliated Hospital of Guangzhou Medical University from June 2010 to May 2010.The dependent variable was the person-time of hypotension, and the 18 independent variables were capacity control , usage of phenylephrine , the variety of anesthetics , intervals of blood pressure measuring , maternal age , height , body weight , body mass index , the dosage of hemabate , the continuous dose and total dosage of phenylephrine , intraoperative dosage of venous transfusion, the amount of liquid input before anesthesia , the total liquid amount , intraoperative blood loss volume, operative time, tactile sensation block level and pressure sensitivity block level .The data were analyzed by multiple linear regression models .According to the usage of phenylephrine , we regrouped the patients into 3 groups:without preventive treatment group , preventive treatment group , preventive treatment plus persistent treatment group .The pH value, base excess (BE) of newborn′s umbilical venous blood and the 1 minute Apgar score after birth of the 3 groups were analyzed by the one-way analysis of variance . Results The multiple linear regression equation for predicting hypotension:the person-time of hypotension=0.218-34.206 the continuous dose of phenylephrine +1.096 the total dosage of phenylephrine -0.214 the variety of anesthetics .The person-time of hypotension of the 3 groups were 3.53 ±2.02, 2.76 ±1.81 and 0.88 ±1.17, respectively.The person-time of hypotension of preventive treatment plus persistent treatment group were obviously less than the other two groups ( P<0.01 ) .The pH value , base excess ( BE) of newborn′s umbilical venous blood and the 1 minute Apgar score after birth of the 3 groups had not any difference ( P >0.05 ) . The results showed that a dose of phenylephrine ( 1 μg/kg ) plus a maintenance dose [0.25-0.35 μg/(kg· min)] through an intravenous injection during CSEA was an effective method to prevent hypotension .Conclusions The maintenance dose of phenylephrine is the main factor for maternal hypotension undergoing elective cesarean section with CSEA .