Effects Of Pre-Fluid-expansion With Crystalloid Or Colloid Fluids On Peri-operative Maternal's Haemodynamics Undergoing Caesarean Section By Continuous Epidural Blockade

Objective: To investigate the effects of pre-fluid-expansion with crystalloid or colloid fluids onperi-operative matemal's undergoing caesarean section by continuous epidural blockade.Methods: 48 pregnants at term undergoing emergency CS by CEA, were divided randomly intofour groups, 12 in each, ASAⅠ-Ⅱ. Monitoring: Bioz.com^? cardiodynamics monitor wasconnected to the patient, an upper limb vein was built after entering operating room,circulatory parameters were recorded as baseline after calming down for 10 minutes.Pre-fluid-expansion: groupⅠandⅢgiven colloid fluid-Voluven injection, groupⅡandⅣ,crystalloid fluid-sodium lactate Ringer's injection at a rate of 20ml.kg^-1.h^-1, at the first 20 mins;Then LR were transfused to all patients lasting to the end of operation at a rate of 8ml.kg-1.h-1.Anesthesia: Epidural blockade was performed at the interspace of L2-3 on left lateral position, anepidural catheter was insertted into epidural space at length of 3.0cm. Then supine withleft-leaning 15°to 20°. 0.75% ropivacaine for groupⅠandⅡ, 2% carbonated lidocaine for groupⅢandⅣ, injected through the catheter at a volume of 12～14mI according to height ofindividuals as the first dosage after 3 ml as a test dose with 2% lidocaine. Until a bilateral T6～S2level of blockade was achieved assessed by loss of sensation to pinprick. 5U Oxytocin wasinfussed intravenously and 20U injected into uterine wall simultaneously after the newborndelivered. Monitoring points: T1 (pre-anesthesia as baseline), T2 (after blockade, before skindisinfection), T3 (after newborn delivery), T4 (2min after delivery), T5 (6min after delivery), T6(10min after delivery) and T7 (at the end of operation). Monitoring parameters: Heart rate (HR),mean artery pressure (MAP), stroke volume (SV), cardiac output (CO=SV×HR), systemicvascular resistance (SVR), left cardic work (LCW), thoracic fluid content (TFC), systolic timeratio (STR=PEP÷LVET).Results: There was no statistical significance of all parametersMonitored among all groups at baseline (p＞0.05). HR, LCW and CO at T2 were higher thanthat of at baseline(p＜0.05, p=0.000～0.013 ), SVR was lower than that of at T1for all groups,(p＜0.05, p=0.000), there was no statistical significance of others besides the abovebetween at T1 and T2; There was no statistical significance among all groups at T2. For allgroups, MAP and SVR at T3 were lower than that of at baseline (p＜0.05, p=0.000～0.032), HR higher than that of at baseline (p＜0.05, p=0.000～0.003), the other parametersmonitored were not significantly different between at T1 and T3; There was no statisticalsignificance among all at T3. MAP and SVR at T4 were lower than that of at baseline (p＜0.05,p=0.000～0.035), the other parameters were no statistical significance between at T4 andbaseline p＞0.05); There was no significant difference among all groups at T4 (p＞0.05). Forall groups, MAP and SVR at T5 were lower than that of at baseline (p＜0.05, p=0.000～0.007), the other parameters were no significant difference between T5 and baseline (p＞0.05); There was no statistical significance among all groups at T5. For all groups, MAP and SVR at T6were lower than that of at baseline (p＜0.05, p=0.000～0.022), the others were no significantdifference between T6 and baseline (p＞0.05); There was no statistical significance among allgroups at T6. For all groups, MAP and SVR at T7 were lower than that of at baseline (p＜0.05,p=0.000～0.001), the others monitored were no statistical significance between T7 andbaseline (p＞0.05); MAP, LCW in groupⅠandⅢwere higher than that of in groupⅡandⅣ(p＜0.05, p=0.000～0.003), SV in groupⅠandⅢwere higher than that of in groupⅡ(p＜0.05, p=0.011～0.044). TFC and STR were similar among all groups during the periods ofanaesthesia. Conclusions:For all groups, the hemodynamic parameters monitored shows adescendent tendency after the CEA. Although statistical significance exists among groups, allwere within normal range. Pre-fluid-expansion is much more beneficial in keeping martemal'shemodynamics stable, there is nothing to do between any kind of fluid, crystalloid or colloidfluid, selected. After newborn deelivered, MAP and LCW in both groupⅠandⅢare higher thanthat of in groupⅡandⅣ, but no clinical values. Pre-fluid-expansion has definitely positiveeffects on preventing maternal's from hypotension caused by the blockade. LCW is lower ingroupⅡandⅣthan that of in other two groups, it shows that pre-fluid-expansion with can getlower myocardial oxygen consumption. MAP,SVR get lower than that of baseline, HR increasescompensatively, SV, CO, LCW rise higher than that of baseline in all groups, it is related tosympathetic nervous blockade accompanied with CEA. The Bioz.com^? can provide overallmaternal's parameters of circulatory function when it is used for continuous monitor during theCS. It has so more advantages to found and manage abnormalities at early stage, that it mayimprove the safety of both maternal and baby during the operation.