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上海市卫生健康委员会
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上海市医学会
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CN31-1366/R
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羟乙基淀粉氯化钠注射液用于剖宫产术患者腰硬联合麻醉前预填充的有效剂量探讨
Studying the effective preloading dose of hydroxyethyl starch sodium chloride (130/0.4) in the caesarean parturients undergoing combined spinal and epidural anesthesia

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DOI:
作者:
李胜华，吴娟，罗威，王长社，陆勤
LI Shenghua,WU Juan ,LUO Wei,WANG Changshe,LU Qin
作者单位:
上海市嘉定区妇幼保健院
Department of Anesthesiology, Maternal and Child Health Hospital , Jiading District, Shanghai
关键词:
万汶；预填充；腰硬联合麻醉；剖宫产
Voluven; Preloading; Combined spinal and epidural anesthesia(CSEA); Caesarean section
摘要:
【摘要】 目的 探讨腰硬联合麻醉前输注羟乙基淀粉130/0.4氯化钠注射液（万汶）预防剖宫产术患者术中低血压的有效剂量。方法 ASAⅠ~Ⅱ级，孕38~40周、第1胎，择期剖宫产手术的产妇160例，随机分为4组(n=40)。A组麻醉前输注5ml/kg平衡液，B、C、D组分别输注5、10、15ml/kg万汶。输注结束后，行L3－4腰硬联合麻醉，鞘内注射5μg舒芬太尼和0.5%等比重罗哌卡因2.4ml（12mg），注射时间为20秒钟。鞘内注药后，向头侧置入硬膜外导管3cm，调整麻醉平面于T6以下。术中血压下降基础值的30%或收缩压低于90mmHg的病例，静脉注射麻黄素10mg/次。观察产妇入室(T1)、输注完(T2)、鞘内注药5min（T3）、10min（T4）、20min（T5）的MAP、HR、SpO2和新生儿1min、5min的Apgar评分。采集产妇入室、输注完的动脉血以及胎儿取出时的脐动脉，行血气分析。记录各组病例静脉注射麻黄素的次数。结果 A组和B组患者的 T3、T4、T5点MAP数值均较T1下降(P<0.05)，尤以A组T4下降明显(P<0.01)，C组、D组各时间点无明显变化；与A组相比较，C组、D组T3、T4的MAP数值均比A组显著升高(P<0.05或0.01)。4组患者SpO2数值在组内各时间点和组间相应时间点均无差异。4组产妇和新生儿脐动血pH、PaO2、PaCO2均无统计学差异(P>0.05)。A组麻黄碱使用率为30%(12/40)，B组麻黄碱使用率为10%(4/40)，2组有统计学差异(P<0.05)，C组、D组均没有使用麻黄碱。4组新生儿1min、5minApgar评分均无统计学差异(P>0.05)。结论 择期行剖宫产患者在腰硬联合麻醉前输注万汶预防术中低血压的有效剂量为10ml/Kg。
【Abstract】 Objective To observe the effetive preloading dose of hydroxyethyl starch sodium chloride 130/0.4 (Voluven) applied before combined spinal and epidural anesthesia (CSEA) to prevent hypotension of parturients undergoing caesarean section . Method One hundred and sixty parturients, ASA I and II, 38 to 40 weeks of pregnancy primiparas scheduled for elective cesarean delivery were enrolled in this prospective and randomized study. Patients were randomized into four groups as Group A: preloading 5mL/kg lactated Ringer’s fluid, Group B:preloading 5ml/kg of Vouluven , Group C: preloading 10 ml/kg of Vouluven, and Group D: preloading 15 ml/kg of Vouluven.After preloading infusion, Spinal-epidural anesthesia was performed at the L3~4 intervertebral space and Sufentanil 5μg combined 0.5% isobaric Ropivacaine 2.4ml (12mg) was intrathecal injected within 20seconds, then epidural catheter was placed with 3cm toward head, and anesthesia level was adjusted below T6. Ephedrine 10mg was applied intravenous when Systolic pressure less than 90mmHg or 30% of baseline. Mean arterial blood pressure (MAP), Heart rate (HR), Saturation of pulse blood oxygen (SpO2) were recorded at the timepoints as T1 and T2 preload infusion finished,T3, T4, T5 and 5minutes、10minutes、20minutes after injection of the anesthetic, Apgar’s scores were recorded the after 1min、5min of neonatal delivered.Maternal arterial blood samples were collected before and immediatedly after preloading infusion, while, umbilical artery blood samples were collected immediatedly after fetus delivered to perform blood gases analysis. Times of Ephedrine applications were also record. Result MAP of patients in group A and group B at T3、T4、T5 timepoints were decreased than that of T1 (p<0.05), especially at T4(p<0.01) in group A. There was no significant difference of MAP between group C and group D (p>0.05), MAP of patients in Group C and D were higher than group A at T3 and T4 (p<0.05 or p<0.01) .When compared the values of pH、PaO2、PaCO2 of the newborn umbilical artery blood samples and maternal arterial blood samples, there were no statistical differences among these 4 groups. Ephedrine application rate was 30%(12/40) in group A and 10%(4/40) in group B (p<0.05), and zero in group C and D. The Apgar’s scores at first minute and fifth minute had no statistical differences among 4 groups (p>0.05). Conclusion 10ml/kg Voluven is the effective preloading dose in preventing hypotention induced by CSEA of parturients undergoing caesarean section.

 

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