剖宫产术中低血压的原因和处理.pdfVIP

医学综述2008年7月第14卷第13期 Medical Recapitulate，Jul 2008．Vo1．14．No．13 剖宫产术中低血压的原因和处理 陈秋芬(综述)，张宗旺(审校) (山东省聊城市人民医院麻醉科，山东聊城252000) 中图分类号：R614-4 文献标识码：A 文章编号：1006-2084(2008)13-2009-03 摘要：椎管内神经阻滞下剖宫产手术中低血压是最常见的并发症。发生低血压时的处理包括 于血管活性物质的释放，引起 改变子宫位置、下肢加压促使静脉血回流、预先静脉输液及血管活性药物的应用等。发生仰卧位 肺血管痉挛，进而出现右心衰 低血压综合征时普遍采取使子宫左偏，下肢加压有效但是应用并不普遍。静脉内输入大量晶体液 竭、心排血量降低、肺水肿、低 升压效果也不明显，输注胶体液有效但是价格昂贵而且有潜在的并发症。血管活性药物如麻黄素 不减少子宫的血流，去氧肾上腺素抗低血压效果好，浓度容易滴定，而且对胎儿的血液pH值和碱 氧、低血压、死亡。 剩余影响较小。 1．1．4 产后出血 阴道分娩 关键词：剖官产手术；椎管内神经阻滞；低血压 的正常失血量大约500 mL，剖 Causes and Trealraent of Hypotension during Caesarean Scion CHEN Qiu 缸n．ZHANc Zong． 宫产大约是1000 mL。宫缩欠 wang．(Department ofAnesthesiology，People sHospital ofLiaocheng，Liaocheng 252000，China) Abslract：Hypotension is the most common colnplieafon of regional anaesthesia for caesal-el锄 sec． 佳是一种不易被察觉的失血 tion．Methods managing hypotension include changing the postion of uterus，promoting the venous return by forcing the lower limbs，intravenous transfusion in advance and using vasoaetive agents．Displacing uterus 源，而严重撕裂伤造成进一步 to the left and forcing the lower limb s are the effective methods commonly used in supine hypotensive syn． 失血可能严重地减少患者的 drome．but its application is not vey popular．Intravenous transfusion of quantity of erystalloid liquids can not achieve good outcome in increasing blood pressure，intravenous tansfusion of coll0jds iS m0fe effective． 血容量。 while it is vey expensive and has potential complications．Among all vasoactive agents．Ephedrine does not reduce the flow of uterus．phenylephrine has good efficacy in anti．hypotension and less influenee on the 1．2 局麻药的作用 局麻药 PH and base excess(BE)of fetal blood．Besides that，its titre is easily dete