预扩容与即时扩容对剖宫产产妇心输出量影响的比较

Effects of preload versus coload on maternal cardiac output in cesarean section under epidural anesthesia

摘要:

目的 比较预扩容与即时扩容对硬膜外麻醉下行剖宫产产妇心输出量的影响。方法 选择择期行剖宫产术的产妇40例，随机分为预扩容组（A组）和即时扩容组（B组），每组各20例。A组以25mL/(kg·h)速度快速输注霍姆250mL+乳酸钠林格液500mL，输注完毕后常规速度输注乳酸钠林格液，开始行连续硬膜外麻醉；B组于硬膜外穿刺置管结束并开始推注局部麻醉药的同时，以25mL/(kg·h)速度快速输注霍姆250mL+乳酸钠林格液500mL。记录入室后基础值（T0），麻醉诱导时（T1），麻醉诱导后5min（T2），麻醉诱导后10min（T3），手术开始时（T4），胎儿娩出时（T5），胎儿娩出后5、10min（T6、T7）以及手术结束时（T8）的心输出量（cardiac output, CO）、每搏量（stroke volume, SV）、心率（heart rate, HR）、总外周阻力指数（total peripheral vascular resistance index, TPRI）、平均动脉压（mean arterial pressure, MAP），记录新生儿Apgar评分，产妇低血压、恶心、呕吐发生次数。结果 A组产妇CO在T1时点高于B组，T7、T8时点低于B组（P＜0.05），其余时点两组间差异无统计学意义（P>0.05）；A组产妇SV在T1时点高于B组，T8时点低于B组（P＜0.05），其余时点两组间差异无统计学意义（P>0.05）。两组的MAP、HR和TPRI差异无统计学意义（P>0.05）。新生儿Apgar评分，产妇低血压及恶心、呕吐的发生次数差异均无统计学意义（P>0.05）。结论 预扩容在麻醉诱导前能有效地提升CO和SV，但在手术后期出现了明显的下降，而即时扩容在术中一直维持着较平稳的CO和SV，且可以节约麻醉前的准备时间。

Abstract:

Objective To compare the effects of preload and coload on the maternal cardiac output in cesarean section under epidural anesthesia. Methods Forty ASA Ⅰ-Ⅱ parturients scheduled for elective cesarean section were randomly divided into group A(preload) or group B(coload). In group A, 250mL Holm and 500mL lactated Ringers solutions were infused at speed of 25mL/(kg·h) before continuous epidural anesthesia; in group B, 250mL Holm and 500mL lactated Ringers solutions were infused at the time of anesthesia induction. Cardiac output(CO), stroke volume (SV), total peripheral vascular resistance index(TPRI), heart rate(HR) and mean arterial pressure(MAP) were recorded at T0(baseline), T1(anesthesia inducing), T2(5 min after induction), T3(10 min after induction), T4(operation beginning), T5(newborn delivery), T6(5 min after delivery), T7(10 min after delivery), and T8(the end of operation). The Apgar score, and the incidence of nausea, vomiting and maternal hypotension was also recorded. Results CO and SV in group A were higher than those in group B at T1(P<0.05); CO in group A was lower than that in group B at T7 and T8(P<0.05); SV was lower in group A than that in group B at T8(P<0.05). There were no significant differences in CO and SV between two groups at the other time points（P>0.05）. The Apgar score, the incidence of common side effects are similar in two groups（P>0.05）. Conclusion CO and SV are decreased significantly in preload group in the late period of the operation, though they are increased before anesthesia induction. CO and SV maintain stable during the whole operation in coload group.