剖宫产术中的母体血流动力学变化：硬膜外麻醉与全身麻醉的比较

Maternal haemodynamic changes during caesarean section: a comparison of epidural and general anaesthesia.

作者信息

Milsom I, Forssman L, Biber B, Dottori O, Rydgren B, Sivertsson R

出版信息

Acta Anaesthesiol Scand. 1985 Feb;29(2):161-7. doi: 10.1111/j.1399-6576.1985.tb02178.x.

DOI:10.1111/j.1399-6576.1985.tb02178.x

Abstract

Haemodynamic measurements were performed on 20 healthy women before and during elective caesarean section under epidural (10 women) or general anaesthesia (10 women). The influence of the two anaesthetic techniques on the haemodynamic changes associated with operative delivery was compared. The following haemodynamic variables were studied: cardiac output (CO), stroke volume (SV) determined non-invasively with impedance cardiography, heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP), pulse pressure, mean arterial pressure (MAP) and total peripheral vascular resistance (TPR). During epidural anaesthesia, SV was largely unchanged before delivery but increased (P less than 0.05) following delivery. However, CO increased (P less than 0.05) prior to delivery due to an increase (P less than 0.01) in HR. A further increase (P less than 0.05) in CO was recorded following delivery. SBP, DBP, MAP and TPR decreased (P less than 0.01) during epidural anaesthesia. In the patients undergoing general anaesthesia, SV decreased (P less than 0.05) prior to delivery. However, CO remained largely unchanged due to an increase (P less than 0.01) in HR. Following delivery, CO (P less than 0.05) and SV (P less than 0.01) increased whereas HR decreased (P less than 0.01). SBP, DBP and MAP increased (P less than 0.01) prior to delivery, returning to the same level as prior to induction of anaesthesia following delivery. TPR was largely unchanged prior to delivery but decreased (P less than 0.01) following delivery.

摘要

对20名健康女性在择期剖宫产硬膜外麻醉（10名女性）或全身麻醉（10名女性）前及术中进行血流动力学测量。比较了两种麻醉技术对与手术分娩相关的血流动力学变化的影响。研究了以下血流动力学变量：心输出量（CO）、通过阻抗心动图无创测定的每搏输出量（SV）、心率（HR）、收缩压（SBP）和舒张压（DBP）、脉压、平均动脉压（MAP）和总外周血管阻力（TPR）。在硬膜外麻醉期间，分娩前SV基本不变，但分娩后增加（P<0.05）。然而，由于HR增加（P<0.01），分娩前CO增加（P<0.05）。分娩后记录到CO进一步增加（P<0.05）。硬膜外麻醉期间SBP、DBP、MAP和TPR降低（P<0.01）。在接受全身麻醉的患者中，分娩前SV降低（P<0.05）。然而，由于HR增加（P<0.01），CO基本保持不变。分娩后，CO（P<0.05）和SV（P<0.01）增加，而HR降低（P<0.01）。分娩前SBP、DBP和MAP增加（P<0.01），分娩后恢复到麻醉诱导前的水平。分娩前TPR基本不变，但分娩后降低（P<0.01）。