共负荷输注不同类型晶体液对剖宫产腰麻产妇及新生儿的影响

摘要/Abstract

摘要： 目的本研究旨在探讨共负荷输注不同类型晶体液对剖宫产腰麻产妇及新生儿的影响。方法选取2023年1月—2024年1月在中国科学技术大学附属第一医院行剖宫产术的165例孕妇为研究对象,采用随机数表法分为乳酸钠林格液组（R组,83例）和钠钾镁钙葡萄糖注射液组（N组,82例）。R组在腰麻开始时30 min共负荷输注15 mL/kg乳酸钠林格液,N组腰麻时共负荷输注15 mL/kg钠钾镁钙葡萄糖注射液。观察并比较两组产妇手术中低血压发生率、血流动力学指标、恶心呕吐发生率、血管活性药用量、新生儿脐带血血气等指标。结果 N组胎儿娩出后低血压发生率、恶心呕吐发生例数低于R组,差异有统计学意义（P< 0.05）;N组总的血管活性药物使用量,新生儿脐带血乳酸值低于R组,差异有统计学意义（P<0.05）。结论共负荷输注钠钾镁钙葡萄糖注射液改善剖宫产腰麻相关低血压的作用优于乳酸钠林格液,对新生儿脐血乳酸水平也有一定的改善作用。

关键词: 剖宫产, 腰麻, 晶体液, 共负荷

Abstract: Objective The aim of this study is to explore the effects of different types of crystalloid co-load on parturients and newborns during spinal anesthesia for caesarean delivery. Methods A total of 165 women undergoing cesarean section under spinal anesthesia in our hospital from January 2023 to January 2024 were randomly allocated to the lactated Ringer's solution group (Rgroup, 83) and the sodium potassium magnesium calcium glucose injection group (Ngroup, 82). Group R received a total infusion of 15 mL/kg lactated Ringer's solution administered rapidly within 30 minutes starting with intrathecal injection (crystalloid co-load) while Group N received a total infusion of 15 mL/kg Sodium Potassium Magnesium Calcium Glucose Injection. The incidence of hypotension, hemodynamic indicators, incidence of nausea and vomiting, dosage of vasoactive drugs, and neonatal umbilical artery blood gas during surgery between two groups were recorded. Results The incidence of hypotension and nausea and vomiting after delivery in group N was lower than that in group R, and the difference was statistically significant (P<0.05); The total amount of vasoactive drugs used in Group N and the lactate value in neonatal umbilical cord blood were lower than those in Group R, and the difference was statistically significant (P<0.05). Conclusion The co-load of sodium, potassium, magnesium, calcium, and glucose injection has a better effect on improving spinal anesthesia related hypotension in cesarean section than lactated Ringer's solution, and also has a certain improvement effect on neonatal umbilical cord blood lactate levels.

Key words: cesarean section, spinal anesthesia, crystalloid, co-load

中图分类号:

R614

王明洋. 共负荷输注不同类型晶体液对剖宫产腰麻产妇及新生儿的影响[J]. 中华养生保健, 2025, 43(12): 58-61.

WANG Ming-yang. The Effect of Different Types of Crystalloid Co-Load on Parturients and Newborns During Spinal Anesthesia for Caesarean Delivery[J]. ZHONGHUA YANGSHENG BAOJIAN, 2025, 43(12): 58-61.

参考文献

[1] 周文琴,倪娟,马玉姗,等.预负荷和共负荷补液对剖宫产术中蛛网膜下腔麻醉相关低血压发生率影响的Meta分析[J].华西医学,2018,33(5):561-568.
[2] 徐丽,嵇富海,陈军,等.托烷司琼预注联合琥珀酰明胶即时扩容对腰硬联合麻醉下剖宫产术产妇循环和新生儿的影响[J].南京医科大学学报:自然科学版,2020,40(3):440-442,453.
[3] 陈洁,汪小海,汤春艳,等.去氧肾上腺素和去甲肾上腺素预防剖宫产腰麻后低血压的研究进展[J].药学与临床研究,2023,31(6):528-533.
[4] 张雪苗,赵文琪,范修颖,等.剖宫产腰麻后低血压预防策略的研究进展[J].牡丹江医学院学报,2021,42(1):132-135.
[5] 张雪苗,岳圆圆,赵文琪,等.盐酸麻黄碱皮下浸润联合晶体共负荷预防剖宫产腰麻后低血压的效果分析[J].中国医学创新,2021,18(22):17-21.
[6] 杨小立,陈莉.单次腰麻剖宫产术中低血压原因分析及对策[J].黑龙江医药,2022,35(2):260-264.
[7] 游俊丽,王晋平.剖宫产腰麻后低血压预测与防治的研究进展[J].系统医学,2022,7(5):185-188.
[8] 于田,赵平.剖宫产围术期液体治疗现状[J].齐鲁医学杂志,2016,31(2):249-251.
[9] 于洋,张龑.产后出血输血和液体复苏[J].实用妇产科杂志,2024,40(3):170-173.
[10] 郭姗姗,刘小会,李草,等.基于循证证据的晶体液和胶体液选择[J].临床药物治疗杂志,2024,22(6):1-5.
[11] 周庆华. 心房利钠肽与心血管疾病的临床研究进展[J].实用心脑肺血管病杂志,2014,22(6):5-6.
[12] RILEY E T,MANGUM K,CARVALHO B,et al.The Crystalloid Co-Load:Clinically as Effective as Colloid Preload for Preventing Hypotension from Spinal Anaesthesia for Caesarean Delivery[J].Turk J Anaesthesiol Reanim,2019,47(1):35-40.
[13] TAWFIK M M,HAYES S M,JACOUB F Y,et al.Comparison between colloid preload and crystalloid co-load in cesarean section under spinal anesthesia:a randomized controlled trial[J].Int J Obstet Anesth,2014,23(4):317-323.
[14] 苏鸿莉,晋雅凌.胶体液预负荷和晶体液共负荷在预防腰麻剖宫产术中低血压效应的临床疗效对比[J].安徽医药,2015,19(11):2210-2212.
[15] MUZLIFAH K B,CHOY Y C.Comparison between preloading with 10 ml/kg and 20 ml/kg of Ringer’s lactate in preventing hypotension during spinal anaesthesia for caesarean section[J].Med J Malaysia,2009,64:114-117.
[16] 张建军,曾思,雷迁,等.血液稀释对脑氧供需平衡的影响研究进展[J].四川医学,2022,43(1):71-74.