2021 年第 1 期 第 16 卷

连续蛛网膜下腔阻滞镇痛对妊娠期高血压疾病产妇围产期血流动力学及分娩结局的影响

Study on hemodynamic changes with continuous spinal anesthesia in parturients with hypertensive disorders in pregnancy

作者：韩斌徐铭军白云波

英文作者：Han Bin Xu Mingjun Bai Yunbo

单位：首都医科大学附属北京妇产医院麻醉科100006

英文单位：Department of Anesthesiology Beijing Obstetrics and Gynecology Hospital Capital Medical University Beijing 100006 China

关键词：妊娠期高血压疾病；连续蛛网膜下腔阻滞镇痛；连续硬膜外镇痛；血流动力学

英文关键词：Hypertensivedisordersinpregnancy;Continuousspinalanesthesia;Continuousepiduralanalgesia;Hemodynamics

• 摘要：

• 目的 探讨连续蛛网膜下腔阻滞镇痛（CSA）对妊娠期高血压疾病产妇围产期血流动力学及分娩结局的影响。方法 选取2019年6月至2020年3月在首都医科大学附属北京妇产医院分娩的妊娠期高血压疾病产妇90例，采用随机数字表法分为CSA组和连续硬膜外镇痛(CEA)组，各45例。剔除中转剖宫产者后CSA组纳入38例，CEA组37例，2组产妇进入产房后连接LiDCO-rapid监测仪和心电监护仪，出现子宫规律收缩后行分娩镇痛，并持续应用镇痛泵至第一产程结束。比较2组产妇第一和第二产程所需时间,各时点血流动力学指标水平，疼痛视觉模拟量表评分，产妇围产期相关治疗，产钳助产、子痫和产后出血发生率，新生儿出生后1、5、10 min的Apgar评分，以及脐带动脉血血气分析指标水平。结果 CSA组第一和第二产程时间均长于CEA组［(608±55)min比（537±88）min，(72±18)min比（53±13）min］，分娩镇痛后10 min和胎头娩出时的收缩压、外周血管阻力和疼痛视觉模拟量表评分均低于CEA组，围产期应用降压药物比例低于CEA组［15.8%（6/38）比40.5%（15/37）］（均P<0.05）。2组均未出现子痫，2组应用缩宫素和产钳助产者比例及产后出血发生率比较差异均无统计学意义（均P>0.05）。2组新生儿出生后1、5、10 min的Apgar评分和脐带动脉血血气分析指标水平比较差异均无统计学意义（均P>0.05）。结论 与传统的CEA比较，妊娠期高血压疾病产妇应用CSA具有血流动力学平稳、减轻产痛、减少降压药物应用的优点，且新生儿和产妇分娩结局良好。

• Objective To investigate the effect of continuous spinal anesthesia (CSA) on hemodynamics and delivery outcome of pregnant women with hypertensive disorder complicated pregnancy. Methods Total 90 pregnant women with hypertensive disorder complicated pregnancy admitted to Beijing Obstetrics and Gynecology Hospital, Capital Medical University from June 2019 to March 2020 were randomly divided into CSA group and continuous epidural analgesia (CEA) group, with 45 cases in each group. After excluding those who were transferred to cesarean section, there were 38 cases in CSA group and 37 cases in CEA group.  After entering the delivery room, the two groups were connected with LiDCO-rapid monitor and electrocardiograph monitor, and labor analgesia was performed after regular uterine contraction. The time of the first and second stage of labor, the levels of hemodynamic indexes and pain visual analogue scale scores, the perinatal treatment, delivery mode, incidence of eclampsia and postpartum hemorrhage, Apgar scores at 1, 5, 10 min after birth, and umbilical artery blood gas analysis indexes were compared between the two groups. Results The time of first and second stage of labor in CSA group  were longer than those in CEA Group ［(608±55)min vs (537±88)min, (72±18)min vs (53±13)min］, systolic blood pressure, systemic vascular resistance and pain visual analog scale scores in CSA group were lower than those in CEA group at 10 min after labor analgesia and at fetal head delivery, and the proportion of antihypertensive drugs used in CSA group was lower than that in CEA Group ［15.8%(6/38) vs 40.5%(15/37)］(all P<0.05). No eclampsia was found in the two groups. There were no significant differences in the proportion of oxytocin and forceps delivery and the incidence of postpartum hemorrhage between the two groups(all P＞0.05). There were no significant differences in Apgar score and umbilical artery blood gas analysis between the two groups at 1, 5, 10 min after birth (all P>0.05). Conclusion Compared with the traditional CEA, the application of CSA in hypertensive disorder complicating pregnancy has the advantages of stable hemodynamics, reducing labor pain and reducing the use of antihypertensive drugs.