基于局部脑氧饱和度的血压管理策略对剖宫产蛛网膜下腔麻醉后低血压的预防效果OA
Effect of blood pressure management strategy based on regional cerebral oxygen saturation on the prevention of spinal anaes-thesia-induced hypotension during cesarean section
目的 探讨基于局部脑氧饱和度(rScO2)的血压管理策略在预防剖宫产蛛网膜下腔麻醉后低血压中的可行性及效果.方法 前瞻性选择2022年8月至2023年8月成都市第二人民医院收治的130例择期剖宫产产妇,按照随机数字表法分为rScO2监测组和常规监测组,每组65例.rScO2监测组在rScO2下降至4.5％基础值时予以升压处理,常规监测组在收缩压下降至80％基础值时予以升压处理.记录麻醉前(T0)、麻醉后1 min(T1)、3min(T2)、5min(T3)、10min(T4)、升压处理时(T5)、胎儿娩出时(T6)、术毕时(T7)的收缩压、心率、rScO2;蛛网膜下腔麻醉后至胎儿娩出前时间加权平均低血压值、低血压例数、首次升压时间、胎儿娩出前升压次数、反应性高血压例数;胎儿娩出前产妇不良反应(头晕、恶心、呕吐、寒战);脐动脉血气分析(酸碱度、碱剩余、乳酸、氧分压、二氧化碳分压、血糖)、新生儿体重、1 min Apgar评分≤7分例数、出生后1、5 min Apgar评分.结果 两组产妇的收缩压、心率、rScO2在组别主效应、时间主效应、组别×时间交互作用差异显著(均P＜0.05).两组产妇T2～T6时收缩压较T0时均明显降低(均P＜0.05);rScO2监测组产妇T2～T5时收缩压明显高于常规监测组(均P＜0.05);rScO2监测组产妇T1～T5时心率较T0时均明显降低(均P＜0.05),常规监测组产妇T1～T4时心率明显低于T0(均P＜0.05),在T5时明显高于T0(P＜0.05);rScO2监测组产妇在T2～T5时心率明显低于常规监测组(均P＜0.05);两组产妇T1～T5时rScO2较T0时均明显降低(均P＜0.05);rScO2监测组产妇在T2～T5时rScO2明显高于常规监测组(均P＜0.05).rScO2监测组产妇的时间加权平均低血压值、蛛网膜下腔麻醉后低血压例数、首次升压时间较常规监测组明显减少(均P＜0.05),胎儿娩出前升压次数较常规监测组明显增加(P＜0.05),反应性高血压例数比较差异无统计学意义(P＞0.05);rScO2监测组的头晕、恶心、呕吐例数均低于常规监测组(均P＜0.05);两组新生儿脐动脉血气分析、出生体重、1 min Apgar评分≤7分例数、1、5 min Apgar评分比较差异均无统计学意义(均P＞0.05).结论 基于rScO2监测的血压管理策略能够减少剖宫产蛛网膜下腔麻醉后低血压的发生率、暴露时间和程度及相关不良反应,血流动力学指标更稳定,对新生儿结局无不良影响,为预防剖宫产蛛网膜下腔麻醉后低血压提供了一种有应用前景的新策略.
Objective To explore the feasibility and effect of blood pressure management strategy based on regional cerebral oxygen saturation(rScO2)in preventing spinal anaesthesia-induced hypotension(SAIH)in cesarean section.Methods A total of 130 elective cesarean section patients admitted to the Chengdu Second People's Hospital from August 2022 to August 2023 were prospectively selected and randomly divided into the rScO2 monitoring group and the conventional monitoring group according to the random number table method,each with 65 cases.In the rScO2 monitoring group,blood pressure was elevated when the rScO2 value decreased to 4.5％of the baseline value,while in the conventional monitoring group,blood pressure was elevated when the systolic blood pressure decreased to 80％of the baseline value.Systolic blood pressure,heart rate,and rScO2 values were recorded at before anesthesia(T0),1 minute after anesthesia(T1),3 minutes after anesthesia(T2),5 minutes after anesthesia(T3),10 minutes after anesthesia(T4),at the time of blood pressure elevation(T5),at the time of fetal delivery(T6),and at the end of the operation(T7).The time-weighted average hypotension value from spinal anesthesia to the time before fetal delivery,the number of hypotension cases,the first blood pressure elevation time,the number of blood pressure elevations before fetal delivery,and the number of cases of reactive hypertension were recorded.The adverse reactions(dizziness,nausea,vomiting,and chills)of the parturients before fetal delivery were recorded.Umbilical artery blood gas analysis(pH,base excess,lactate,partial pressure of oxygen,partial pressure of carbon dioxide,and blood glucose),neonatal weight,and the number of cases with Apgar score ≤7 at 1 minute after birth,as well as Apgar scores at 1 minute and 5 minutes after birth were recorded.Results There were significant differences in the main effects of group,time,and group × time interaction in systolic blood pressure,heart rate,and rScO2 values between the two groups(all P＜0.05).The systolic blood pressure of both groups decreased significantly at T2 to T6 compared with T0(all P＜0.05).The systolic blood pressure of the rScO2 monitoring group was significantly higher than that of the conventional monitoring group at T2 to T5(all P＜0.05).The heart rate of the rScO2 monitoring group decreased significantly at T1 to T5 compared with T0(all P＜0.05),while the heart rate of the conventional monitoring group decreased significantly at T1 to T4 compared with T0(all P＜0.05)and increased significantly at T5 compared with T0(P＜0.05).The heart rate of the rScO2 monitoring group was significantly lower than that of the conventional monitoring group at T2 to T5(all P＜0.05).The rScO2 values of both groups decreased significantly at T1 to T5 compared with T0(all P＜0.05).The rScO2 of the rScO2 monitoring group was significantly higher than that of the conventional monitoring group at T2 to T5(all P＜0.05).The time-weighted average hypotension value,the number of hypotension cases after spinal anesthesia,and the first blood pressure elevation time of the rScO2 monitoring group were significantly lower than those of the conventional monitoring group(all P＜0.05),while the number of blood pressure elevations before fetal delivery was significantly higher(P＜0.05).There was no significant difference in the number of cases of reactive hypertension between the two groups(P＞0.05).The number of cases of dizziness,nausea,and vomiting in the rScO2 monitoring group was significantly lower than that in the conventional monitoring group(all P＜0.05).There were no significant differences in umbilical artery blood gas analysis,birth weight,the number of cases with Apgar score ≤7 at 1 minute after birth,and Apgar score at 1 minute and 5 minutes between the two groups(all P＞0.05).Conclusion The blood pressure management strategy based on rScO2 monitoring can reduce the exposure time and degree,incidence,and related adverse reactions of spinal anaesthesia-induced hypotension for cesarean section,and the hemodynamic indicators are more stable.It has no adverse effects on neonatal outcomes and provides a promising new strategy for preventing spinal anaesthesia-induced hypotension for cesarean section.
刘佳;谢科宇;何敬熹;朱波
610017 四川大学华西临床医学院,四川大学附属成都市第二人民医院,成都市第二人民医院麻醉科610017 四川大学华西临床医学院,四川大学附属成都市第二人民医院,成都市第二人民医院麻醉科610017 四川大学华西临床医学院,四川大学附属成都市第二人民医院,成都市第二人民医院麻醉科610017 四川大学华西临床医学院,四川大学附属成都市第二人民医院,成都市第二人民医院麻醉科
局部脑氧饱和度血压管理剖宫产蛛网膜下腔麻醉后低血压
Regional cerebral oxygen saturationBlood pressure managementCesarean sectionSpinal anaesthesia-induced hypotension
《浙江医学》 2026 (5)
517-522,527,7
四川省卫生健康委员会医学科技项目(21PJ140)成都市卫生健康委员会医学科技项目(2023045)
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