Clinical effect of prefilled Hydroxyethyl starch combined with Phenylephrine infusion to prevent supine syndrome during cesarean section
HU Ming-xiu1 YU Wang-jun2 ZHOU Liu-yu3 WU Gang1 CHEN Ru-kang1
1.Department of Anesthesiology,Dongguan Shuixiang Central Hospital,Guangdong Province,Dongguan 52314
2,China;
2.Department of Medical Quality Control,Dongguan Shuixiang Central Hospital,Guangdong Province,Dongguan 523142,China;
3.Department of Obstetrics and Gynecology,Dongguan Shuixiang Central Hospital,Guangdong Province,Dongguan 523142,China
摘要目的 探讨预充羟乙基淀粉联合输注去氧肾上腺素预防剖宫产术中仰卧位综合征发生的临床效果。方法 选取2019年4月～2020年4月广东省东莞市水乡中心医院收治的108例剖宫产产妇，依据随机数表法分为A、B、C三组，每组各36例。A组于麻醉前30 min 予以复方氯化钠注射液静脉滴注，B、C 两组于麻醉前30 min 予以羟乙基淀粉静脉滴注，C组于麻醉成功后立刻输注去氧肾上腺素。比较三组麻醉前（T1）、麻醉后1 min（T2）、麻醉后3 min（T3）、麻醉后5 min（T4）及麻醉后10 min（T5）的收缩压（SBP）、舒张压（DBP）、心率（HR）变化情况，新生儿1 min、5 min Apgar评分以及麻醉过程中仰卧位综合征发生率。结果 三组T1时SBP、DBP及HR指标比较，差异无统计学意义（P＞0.05）。相较T1，A组SBP于T3、T4、T5时下降，B组SBP于T3、T4时下降，C组SBP于T3时上升，差异均有统计学意义（P＜0.05）。相较T1，A组DBP于T2、T3、T4时下降，B组DBP于T3、T4、T5时下降，C组DBP于T3时上升，差异均有统计学意义（P＜0.05）。相较T1，A组HR于T2、T3、T4、T5上升，B组HR于T3、T4、T5上升，差异均有统计学意义（P＜0.05）。相较T1，C组HR于T2、T3、T4、T5 均较稳定，差异无统计学意义（P＞0.05）。相较A组，B组SBP于T4时较高，C组SBP于T3、T4、T5时较高，B组DBP于T4、T5时较高，C组DBP于T2、T3、T4、T5时较高，B组HR于T3、T4时较低，C组HR于T2、T3、T4、T5时较低，差异均有统计学意义（P＜0.05）；相较B组，C组SBP于T2、T3、T4、T5时较高，C组DBP于T2、T3、T4时较高，C组HR于T2、T3、T4时较低，差异有统计学意义（P＜0.05）。C组新生儿1 min Apgar评分高于A、B 两组，差异有统计学意义（P＜0.05）；三组新生儿5 min Apgar评分均高于1 min Apgar评分，差异有统计学意义（P＜0.05）；三组新生儿的5 min Apgar评分比较，差异无统计学意义（P＞0.05）；比较A、B两组1 min 与5 min Apgar评分，差异无统计学意义（P＞0.05）。C组的仰卧位综合征发生率低于A、B组，差异有统计学意义（P＜0.05）。结论 剖宫产产妇采用预充羟乙基淀粉联合输注去氧肾上腺素预防仰卧位综合征发生效果显著，可有效改善产妇血压并降低仰卧位综合征发生率，且对新生儿Apgar评分有改善作用，保障母婴安全，值得临床推广。
Abstract：Objective To explore the clinical effect of prefilled Hydroxyethyl starch combined with Phenylephrine infusion to prevent the occurrence of supine syndrome during cesarean section.Methods A total of 108 women accepting cesarean section admitted to Dongguan Shuixiang Central Hospital from April 2019 to April 2020 were selected.According to the random number table method,they were divided into three groups,A,B and C,with 36 cases in each group.In group A,compound sodium chloride injection in intravenous drip was used 30 min before anesthesia.In group B and C,intravenous drip of Hydroxyethyl starch 30 min before anesthesia was applied,and in group C,Phenylephrine was immediately added after successful anesthesia.The changes of systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR) of the three groups before anesthesia (T1),1 min after anesthesia (T2),3 min after anesthesia (T3),5 min after anesthesia (T4) and 10 min after anesthesia (T5),1 min and 5 min Apgar score of newborns,and incidence of supine syndrome during anesthesia were compared.Results There were no significant differences in SBP,DBP and HR indicators among the three groups at T1 (P>0.05).Compared with T1,the SBP of group A decreased at T3,T4,and T5,the SBP of group B decreased at T3 and T4,the SBP of group C increased at T3,the differences were statistically significant (P<0.05).Compared with T1,the DBP of group A decreased at T2,T3,and T4,the DBP of group B at T3,T4,and T5 decreased,the DBP of group C increased at T3,the differences were statistically significant (P<0.05).Compared with T1,the HR of group A increased at T2,T3,T4,and T5,the HR of group B increased at T3,T4,T5,the differences were statistically significant (P<0.05).Compared with T1,HR of group C was more stable at T2,T3,T4,T5,and the difference was not statistically significant (P>0.05).Compared with group A,the SBP of group B was higher at T4,in group C was higher at T3,T4,T5.The DBP in group B was higher at T4 and T5,and in group C was higher at T2,T3,T4,and T5.The HR in group B at T3 and T4 was lower and in group C,HR was lower at T2,T3,T4,and T5,the differences were statistically significant (P<0.05).Compared with group B,the SBP of group C increased at T2,T3,T4,and T5 and the DBP of group C was higher at T2,T3,and T4,and the HR of group C was lower at T2,T3,and T4,the differences were statistically significant (P<0.05).The 1 min Apgar score of newborns in group C was higher than that of group A and B,and the differences were statistically significant (P<0.05).5 min Apgar score was higher than that of 1 min in all three groups,and the differences were statistically significant (P<0.05).There was no statistical difference in 5 min Apgar score of the three groups (P>0.05).There was no significant difference in Apgar score between group A and B at 1 min and 5 min (P>0.05).The incidence of supine syndrome in the group C was lower than that of the A and B group,the differences were statistically significant (P<0.05).Conclusion The prefilled Hydroxyethyl starch combined with Phenylephrine infusion for cesarean parturient women has a remarkable effect on preventing the occurrence of supine syndrome,which can effectively improve the blood pressure and reduce the incidence of supine syndrome,and incrase the Apgar score of newborns.It can protect the safety of mother and child and is worthy of clinical promotion.
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