文章摘要
目标导向液体治疗对剖宫产术产妇蛛网膜下腔阻滞后低血压的影响
Effect of goal-directed fluid therapy on maternal hypotension during spinal anesthesia for cesarean section
  
DOI：10.12089/jca.2022.09.001
中文关键词: 目标导向液体治疗  蛛网膜下腔阻滞  低血压  经胸壁超声
英文关键词: Goal-directed fluid therapy  Spinal anesthesia  Hypotension  Transthoracic echocardiography
基金项目:
作者单位E-mail
张悦 210004,南京医科大学附属妇产医院（南京市妇幼保健院）麻醉科  
冯善武 210004,南京医科大学附属妇产医院（南京市妇幼保健院）麻醉科 iamfsw@163.com 
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中文摘要:
      
目的 评价经胸壁超声（TTE）指导的目标导向液体治疗（GDFT）对降低剖宫产术产妇蛛网膜下腔阻滞后低血压发生率的影响。
方法 选择于蛛网膜下腔阻滞下行择期剖宫产术产妇128例，年龄18~35岁，BMI≤30 kg/m2，ASA Ⅱ级。将产妇随机分为两组：对照组（C组）和GDFT组（T组），每组64例。C组在胎儿娩出前输注复方乳酸钠20 ml·kg-1·h-1，胎儿娩出后减至5 ml·kg-1·h-1。T组产妇在蛛网膜下腔阻滞后3 min内输注复方乳酸钠3 ml/kg，在TTE指导下使每搏变异度（ΔSV）≤10%，行GDFT前后输注复方乳酸钠5 ml·kg-1·h-1。记录输液量、术中低血压的发生情况、去氧肾上腺素用量、术后24 h出血量和术后住院时间。记录麻醉前（t0）、蛛网膜下腔阻滞注药完成后5 min（t1）、胎儿娩出时（t2）和蛛网膜下腔阻滞注药完成后15 min（t3）的HR、SBP、DBP、SV和CO。
结果 与C组比较，T组输液量明显减少、术中低血压发生率明显降低、去氧肾上腺素用量明显减少（P＜0.05）。与t0时比较，两组t1、t2、t3时SBP均明显降低（P＜0.05），C组t1时SV明显减少、t2时SV明显增加、t2、t3时CO明显增加（P＜0.05），T组t2时CO明显增加（P＜0.05）。两组术后24 h出血量和术后住院时间差异无统计学意义。
结论 基于TTE指导的以SV为导向的GDFT可降低择期剖宫产术产妇蛛网膜下腔阻滞后低血压的发生率，有利于维持蛛网膜下腔阻滞后CO稳定。
英文摘要:
      
Objective To evaluate the effect of goal-directed fluid therapy (GDFT) guided by transthoracic echocardiography (TTE) on reducing hypotension during spinal anesthesia for cesarean section.
Methods A total of 128 pregnant women, aged 18-35 years, BMI ≤ 30 kg/m2, ASA physical status Ⅱ, who planning to receive selective cesarean section were randomly divided into two groups: the control group (group C) and GDFT group (group T), 64 patients in each group. In group C, the infusion rate of LR was 20 ml·kg-1·h-1 before delivery while the rate was 5 ml·kg-1·h-1 after delivery. Women in group T received an individualized fluid therapy protocol immediately after spinal anesthesia which involved infusing lactated Ringer's solution (LR) of 3 ml/kg within 3 minutes for maintaining of a stroke volume variation <10% and the infusion rate was 5 ml·kg-1·h-1 in addition to GDFT. HR, SBP, DBP, stroke volume (SV), and cardiac output (CO) were recorded at baseline (t0), 5 minutes following spinal anesthesia (t1), immediate after delivery (t2), and 15 minutes following spinal anesthesia (t3). Infusion volume, occurrence of intraoperative hypotension, dosage of norepinephrine, 24 hours postoperative blood loss and postoperative hospital stay were recorded.
Results Compared with group C, the incidence of intraoperative hypotension in group T was significantly decreased (P < 0.05), and the dosage of norepinephrine and intraoperative infusion in group T were significantly decreased (P < 0.05). Compared with t0, SBP decreased significantly at t1, t2, and t3 in both groups (P < 0.05), SV at t1 was significantly reduced and SV was significantlyincreased at t2 in the group C (P < 0.05), CO at t2 and t3 was increased significantlyin group C, while CO at t2 was increased significantly in group T (P < 0.05). There were no significant differences in maternal postoperative bleeding and hospital length of stay between the two groups.
Conclusion SV-directed GDFT guided by TTE can reduce the occurrence of hypotension during spinal anesthesia for elective cesarean section, and play a certain role in maintaining the stability of maternal CO after spinal anesthesia.
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