上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (5): 620-.doi: 10.3969/j.issn.1674-8115.2012.05.019

• 论著（临床研究） • 上一篇    下一篇

健康产妇硬膜外麻醉下行择期剖宫产围术期的循环功能变化

张 洁, 王珊娟, 闻大翔, 周仁龙, 杭燕南   

  1. 上海交通大学 医学院附属仁济医院麻醉科, 上海 200001
  • 出版日期:2012-05-28 发布日期:2012-06-01
  • 通讯作者: 闻大翔, 电子信箱: wdxrwj@126.com。
  • 作者简介:张 洁（1978—）, 女, 主治医师, 硕士；电子信箱: zhangjieshanghai@hotmail.com。
  • 基金资助:

    上海交通大学医学院麻醉重点学科基金（2008-06）

Perioperative circulatory changes in healthy pregnant women undergoing selective cesarean section with epidural anesthesia

ZHANG Jie, WANG Shan-juan, WEN Da-xiang, ZHOU Ren-long, HANG Yan-nan   

  1. Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
  • Online:2012-05-28 Published:2012-06-01
  • Supported by:

    Shanghai Jiaotong University School of Medicine Foundation, 2008-06

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摘要：

目的 监测健康产妇在硬膜外麻醉下择期剖宫产手术时围术期循环功能的变化。方法 53例择期在硬膜外麻醉下行剖宫产的足月健康产妇，美国麻醉师协会（ASA）评级为Ⅰ～Ⅱ级，常规监测血压、心率和脉氧饱和度，同时采用无创监测仪连续监测心输出量等各项指标的变化。比较各指标在麻醉前（基础值）、阻滞平面满意～皮肤消毒前、按压宫底、胎儿娩出即刻、胎盘剥离即刻、胎儿娩出后15 min和30 min、手术结束即刻、麻醉后2 h（T1~T9）各时间点之间的差异。结果 在整个围术期，产妇的胸腔液体量无明显改变（P＞0.05）；其他各循环参数的显著性改变主要集中在胎儿娩出前后，心率、左心室泵血功能指标（每搏输出量/每搏指数、心输出量/心脏指数）、左心室收缩功能指标（速率指数、加速指数、左心室射血时间、左心做功/做功指数）在胎儿娩出前后均明显高于基础值及麻醉后2 h（P<0.05）；平均动脉压、前后负荷指标（体循环血管阻力/阻力指数）、左心室收缩功能指标（预射血期、收缩时间比率）则在胎儿娩出前后明显低于基础值及麻醉后2 h（P<0.05）。结论 在硬膜外麻醉下行择期剖宫产手术的健康产妇，通过自身调节代偿及合理的麻醉管理，能基本维持循环功能的稳定。

关键词: 麻醉, 硬膜外, 阻抗心动图, 循环监测, 剖宫产

Abstract:

Objective To monitor the perioperative circulatory changes in healthy pregnant women undergoing selective cesarean with epidural anesthesia. Methods Fifty-three full-term healthy pregnant women with American Society of Anesthesiologists (ASA)Ⅰ to Ⅱ undergoing selective cesarean with epidural anesthesia were enrolled. Blood pressure, heart rate and pulse oxygen saturation were routinely monitored, and the changes of parameters such as cardiac output were continuously monitored with noninvasive monitoring instrument. The parameters were compared among different time points of baseline (before anesthesia), from satisfactory block level to skin sanitization, gentle fundal massage, fetal disengagement, separation of placenta, 15 min after fetal disengagement, 30 min after fetal disengagement, the end of operation and 2 h after anesthesia. Results There was no significant change in thoracic fluid content during operation （P＞0.05）. The heart rate, left ventricular pumping indexes （stroke volume/stroke volume index, cardiac output/cardiac index）and left ventricular systolic indexes （velocity index, acceleration index, left ventricle ejection time and left cardiac work/left cardiac work index) before and after fetal disengagement were significantly higher than those of baseline and 2 h after anesthesia （P<0.05）. However, the mean arterial pressure, preload and afterload parameters (systemic vascular resistance/systemic vascular resistance index) and left ventricular systolic parameters (pre-ejection period and systolic time ratio) before and after fetal disengagement were significantly lower than those of baseline and 2 h after anesthesia (P<0.05). Conclusion Healthy women undergoing selective cesarean with epidural anesthesia may adapt to circulatory changes by self-compensation and proper anesthetic management.

Key words: anesthesia, epidural, impedance cardiogram, circulatory monitoring, cesarean