2021 年第 2 期 第 16 卷

先兆子痫产妇剖宫产术中不同液体扩容效果临床观察

Clinical observation of effects of different fluid expansion on preeclampsia women during cesarean section

作者：葛彦虎白杨郇利莉马骏

英文作者：Ge Yanhu Bai Yang Huan Lili Ma Jun

单位：首都医科大学附属北京安贞医院麻醉中心100029

英文单位：Anesthesia Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：先兆子痫；乳酸钠林格液；羟乙基淀粉；琥珀酰明胶 

英文关键词：Preeclampsia;SodiumlactateRinger′ssolution;Hydroxyethylstarch;Succinylatedgelatin

• 摘要：

• 目的 观察先兆子痫产妇行剖宫产术中分别应用乳酸钠林格液、羟乙基淀粉和琥珀酰明胶扩容的效果。方法 选取2018年1月至2020年6月首都医科大学附属北京安贞医院先兆子痫行剖宫产手术的产妇60例。完全随机分为乳酸钠林格液组、羟乙基淀粉组、琥珀酰明胶组，各20例。3组术中分别用乳酸钠林格液、羟乙基淀粉和琥珀酰明胶补液。采集围术期血流动力学指标，统计术中发生低血压、心动过速或心动过缓的次数和使用血管活性药物次数。胎儿出生时取新生儿脐动脉血行血气分析。结果 羟乙基淀粉组和琥珀酰明胶组产妇发生心动过速的比例显著低于乳酸钠林格液组，低血压发生次数、应用血管活性药物次数显著少于乳酸钠林格液组［35.0%（7/20）、25.0%（5/20）比55.0%（11/20），1（0，2）、1（1，1）次比4（3，5）次，（2.2±1.1）、（2.1±1.1）次比（6.3±1.0）次］，新生儿脐动脉血血气分析氧分压、碱剩余值显著高于乳酸钠林格液组，二氧化碳分压显著低于乳酸钠林格液组（均P<0.05）。结论 先兆子痫产妇行剖宫产术过程中行液体扩容治疗，应用羟乙基淀粉、琥珀酰明胶比用乳酸钠林格液补液更有利于术中产妇血流动力学平稳和新生儿内环境稳定。

• Objective To observe the fluid expansion effect of sodium lactate Ringer′s solution, hydroxyethyl starch and succinylated gelatin on cesarean section in preeclampsia women. Methods From January 2018 to June 2020, 60 pregnant women with preeclampsia who underwent cesarean section in Beijing Anzhen Hospital, Capital Medical University were enrolled. They were randomly divided into sodium lactate Ringer′s solution group, hydroxyethyl starch group and succinylated gelatin group, with 20 cases in each group. The three groups were given sodium lactate Ringer′s solution, hydroxyethyl starch and succinylated gelatin to fluid infusion, respectively. Hemodynamic indexes were collected during the perioperative period, and the times of hypotension, tachycardia or bradycardia as well as the times of using vasoactive drugs were counted. The umbilical artery blood was collected for detecting blood gas analysis. Results  The incidence of tachycardia in the hydroxyethyl starch group and succinylated gelatin group was  significantly lower than that in the sodium lactate Ringer′s solution group; the frequencies of hypotension and using vasoactive drugs in hydroxyethyl starch group and succinylated gelatin group were significantly less than those in the sodium lactate Ringer′s solution group［35.0%（7/20）,25.0%（5/20） vs 55.0%（11/20）; 1（0，2）,1（1，1）times vs  4（3，5）times; （2.2±1.1）, （2.1±1.1）times vs （6.3±1.0）times］; the oxygen partial pressure and alkali residual value of hetastarch group and succinylated gelatin group were significantly higher than those of sodium lactate Ringer′s solution group, and the carbon dioxide partial pressure of hydroxyethyl starch group and succinylated gelatin group were significantly lower than that of sodium lactate Ringer′s solution group(all P<0.05). Conclusion Fluid expansion therapy during cesarean delivery for preeclampsia parturient, the applications of hydroxyethyl starch and succinylated gelatin are more conducive to the stabilities of maternal hemodynamics and neonatal internal environment than those of sodium lactate Ringer′s solution.