急性高容量血液稀釋對(duì)腰麻下剖宮產(chǎn)術(shù)中低血壓的防治

1、急性高容量血液稀釋對(duì)腰麻下剖宮產(chǎn)術(shù)中低血壓的防治 急性高容量血液稀釋對(duì)腰麻下剖宮產(chǎn)術(shù)中低血壓的防治王漠 1 陳紹洋 2 朱蔚琳 11 河南義馬煤業(yè)集團(tuán)總醫(yī)院麻醉科，河南義馬，472300，2 西京醫(yī)院麻醉科，710033Acute Hypervolume Hemodilution for Prevention of Spinal Hypotension during Cesarean SectionWANG Mo

2、1 , CHEN Shao-Yang2 ,ZHU Wei-Lin 11 Department of Anesthesiology, the General Hospital of Yima Mineral Co.Group,Yima 472300,China,2Department of Anesthesiology ,Xijing Hospital,Xi'an 710

3、033,China[Abstract]AIM:To determine whether acute hypervolume hemodilution (AHH) with low molecule 6% hetastarch and Ringer's solution decreases the incidence of spinal hypotension during the

4、cesarean section(CS).METHODS:52 ASAⅠ～Ⅱ healthy parturients having CS were randomly divided into two groups.Those in groupⅠ(n=20) and groupⅡ(n=32) were received 200ml of Ringer's solution

5、,combined 500ml of 6% low molecule hetasearch and 500ml of Ringer's solution within 20 min pre-spinal anesthesia respectively. Spinal anesthesia was performed with 10mg of 0.5% bupivaca

6、ine hyperbaric soloution in all parturients.Hypotension lasting ≥2 min was treated with IV bolous of ephedrine 10mg. The neonatal Apgars scores were recorded. The incidences of spinal hypoten

7、sion, nausea and vomiting and event such as use ephedrine were compared between the two groups.RESULTS:The incidences of spinal hypotension, nausea and vomiting and event such as admini-stration of ephe

8、drine in groupⅡwere signifcantly lower than those in groupⅠ(P＜0.01).The neonatal Apgar scores were good and similar in both groups(P＞0.05).CONCLUSION:The AHH with 6% low molecule hetastarch and Ringer&#

9、39;s solution can effectively prevent spinal hypotension during CS.[Keywords]hetastarch,low molecule;Ringer's solution; acute hypervolume hemodilution; anesthesia ,spinal ;hypotension ;cesarean sec

10、tion 摘要 目的：觀察“706”代血漿聯(lián)合復(fù)方氯化鈉行高容血液稀釋（AHH）對(duì)剖宮產(chǎn)術(shù)腰 麻后低血壓的防治效果。方法：52 例 ASA-Ⅰ~Ⅱ級(jí)擬行剖宮產(chǎn)術(shù)的健康初產(chǎn)婦，隨機(jī)分入 Ⅰ組（n=20），Ⅱ組（n=32）。兩組患者分別于腰麻前 20min 內(nèi)靜脈輸注復(fù)方氯化鈉 200ml，復(fù)方氯化鈉及“706”代血漿各 500ml。均采用 10mg0.5%布比卡因重比重液實(shí)施腰 麻，腰麻后低血壓持續(xù)超過 2min 者，靜注麻黃素 1

11、0mg。比較兩組腰麻后低血壓、惡心、 嘔吐等的發(fā)生率及麻黃素應(yīng)用率。同時(shí)比較兩組新生兒 Apgar 評(píng)分。結(jié)果：Ⅱ組腰麻后低 血壓發(fā)生率較低（P＜0.01），惡心、嘔吐并發(fā)癥少（P＜0.01），麻黃素使用率低（P＜ 0.01），同Ⅰ組相比有顯著的統(tǒng)計(jì)學(xué)差異。兩組新生兒 Apgar 評(píng)分相仿，均較好。結(jié)論： 以復(fù)方氯化鈉聯(lián)合“706”代血漿行 AHH 可有效防治剖宮產(chǎn)術(shù)腰麻后低血壓的發(fā)生。關(guān)鍵詞 “706”代血漿；復(fù)方氯化鈉；急性高容血

12、液稀釋；麻醉，脊髓；低血壓；剖宮 產(chǎn)術(shù)0 引言 近年來，腰麻在剖宮產(chǎn)術(shù)中應(yīng)用有增加的趨勢(shì)[1]，然而該類患者腰麻后低血壓的有 效、合理防治仍是一個(gè)倍受關(guān)注的問題。有學(xué)者報(bào)道剖宮產(chǎn)術(shù)患者腰麻前輸注 500ml 賀斯 及乳酸林格氏液 1000ml 可明顯降低腰麻后低血壓的發(fā)生率，并推崇賀斯應(yīng)常規(guī)應(yīng)用[2]。然 而賀斯價(jià)格相對(duì)較高，本文擬觀察腰麻前預(yù)先快速靜注低分子量的“706”代血漿及復(fù)方氯化 鈉行高容血液稀釋（AHH）對(duì)剖宮產(chǎn)術(shù)患者腰麻后

13、低血壓的防治效果。1 資料和方法 1.1 一般資料 選擇 ASAⅠ～Ⅱ級(jí)，擬行子宮下段剖宮產(chǎn)術(shù)的健康初產(chǎn)婦 52 例。術(shù)前 檢查示心、肺、肝、腎及凝血功能均無異常，Hb≥110g.l-1、Hct≥33%。依是否行 AHH 隨機(jī) 分成兩組：Ⅰ組為對(duì)照組（n=20），年齡 25±2.4 歲，身高 160±3.6cm，體重 65.8±9.1kg； Ⅱ組為實(shí)驗(yàn)組（n=32），年齡 26±2.4 歲，身

14、高 159.1±2.9cm，體重 66.4±10.3kg。1.2 麻醉方法 麻醉前 30min 肌注魯米那 0.1、胃復(fù)安 10mg。入室后測(cè)定基礎(chǔ)血壓。統(tǒng) 一經(jīng)右上肢開放兩路靜脈供擴(kuò)容補(bǔ)液，并經(jīng)鼻導(dǎo)管吸氧 5L/min。均于左側(cè)臥位下經(jīng) L2-3 間 隙行蛛網(wǎng)膜下腔穿刺，待清亮的腦脊液流出后，按相同注藥速率向頭側(cè)推注 0.5%布比卡因 重比重液 2ml 行腰麻。產(chǎn)婦平臥后墊高右側(cè)臀部，由一名護(hù)士左旋子宮，以減少

15、仰臥位綜要禁用本法，以免貧血加重，不利于全身氧供的維持。由于條件所限，我們未測(cè)臍血的血?dú)庵?。但從兩組 1min、5min 兩時(shí)刻的 Apger 評(píng)分上 看兩組無差別，均達(dá) 8 分以上。其原因可能是：⑴新式剖宮產(chǎn)切皮至胎兒娩出時(shí)間較短； ⑵低血壓的及時(shí)處理使其持續(xù)時(shí)間短暫，與 Ramanathan 等[8]“短暫的母體低血壓并不影響 新生兒體內(nèi)酸堿狀態(tài)”的結(jié)論相符?？傊?，于腰麻前 20min 內(nèi)快速靜注復(fù)方氯化鈉及“706”代血漿各 50

16、0ml 行 AHH 可良好 防止腰麻下剖宮產(chǎn)術(shù)中的低血壓，不僅安全有效，且價(jià)格低廉，有一定的應(yīng)用價(jià)值。參考文獻(xiàn)1. 徐啟明、李文碩，臨床麻醉學(xué).第 1 版.北京：人民衛(wèi)生出版社，2000.315 2. Riley ET,Cohen SE,Rubenstein AJ,et al.Prevention of hypotension after spinal anesthesia for cesarean section :Six p

17、ercent Hetastarch versus lactated ringer's solutin.Anesth Analg 1995;81:838-42 3. Mercier FJ,riley ET,Frederickson WL,et al.Phenylephrine added to prophylactic ephedrine infusion during spinal anesthesia for ele

18、ctive cesarean section. Anesthesiology 2001;95:668-74 4. Ngan Kee WD,Lau TK,Khaw KS,et al.Comparison of metaraminol and ephedrine infusions for maintaining arterial pressure during spinal anesthesia for elective ces

19、arean section.Anesthesiology2001;95:307-13 5. Jackson R,Reid J A,Thorburn J.Volume preloading is not essential to prevent spinal-induced hypotension at caesarean section. Br J Anaesth 1995;75:262-5 6. Ueyama H,Yan-Ling

20、 H,Tanigami H,et al.Effects of crystalloid and colloid preload on blood volume in the parturient undergoing spinal anesthesia for elective caesarean section.Anesthesiology 1999;1571-6 7. Frolich MA.Role of the atrial na

21、trinuretic factor in obstetric spinal hypotension.Anesthesiology 2001;95:371-6 8. Ramanathan S,Grant GJ.Vasopressor therapy for hypotension due to epidural anesthesia for cesarean section.Acta Anaesthesiol