Effect Of Maternal Circulation Function To Infuse Different Capacity Of Colloid On Combined Spinal-epidural Anesthesia Cesarean Section

Objective:To assess the effect of filling Hydroxyethyl starch130/0.4on combined spinal-epidural anesthesia for cesarean delivery on maternal circulation function in the operation process. Methods:With the approval of the hospital ethics committee, randomly selected a number of maternals to hospital cesarean section in the production from September2012to October2013,in the end there were120eligible cases randomly divided them into A,B and C groups,40cases in each group to complete experimental observation. Every patient received routine NBP、ECG and SPO2monitoring and oxygen providing5L/min by oxygen mask. Immediately after opening the upper limb vein, respectively input pre infusion of Hydroxyethyl starch130/0.42.5ml/kg,5.0ml/kg and10.0ml/kg in half an hour before starting the anesthesia. When pre-expansion was completed, took combined spinal-epidural anesthesia (CSEA) in lateral position. Systolic blood pressure (SBP), diastolic blood pressure(DBP), heart rate(HR) and SpO2were recorded in the following points:before the infusion(TO), after the infusion(Tl), before CSEA(T2) and5minutes(T3),10minutes(T4),15minutes(T5) after CSEA. The number of adverse reactions such as hypotension, nausea and vomiting and ephedrine requirements were recorded too, beyond that, the time point of hypotension,the fetal Apgar score of1minute and5minutes, amount of transfusion, urine, blood loss in the process of operation were recorded too. When the systolic blood pressure is decreased more than30%of the base value or below90mmHg, give ephedrine6mg,repeat this when necessary. Results:In group A, five minutes after drug injection(T3point),SBP and DBP decreased remarkably (P＜0.01), while HR of five minutes after drug injection(T3point) increased remarkably(P<0.01) too.In B and C groups, five minutes after drug injection(T3point),SBP decreased remarkably(P<0.01), and DBP decreased significantly(P<0.05),HR of five minutes after drug injection(T3point) increased significantly(P<0.05).Comparison between the three groups, in B and C groups,five minutes after drug injection(T3point), SBP and DBP decreased significantly less than that of group A (P<0.05);In group C, five minutes(T3) and ten minutes(T4) after drug injection,HR changed less than that of group A (P<0.05),while in group B,only at T3point HR increased less than that in group A. Five minutes(T3) and ten minutes(T4) after drug injection,the variation of blood pressure and heart rate between groups B and C was not obvious,having no statistical significance(P>0.05).There was no statistical deference at another points between the three groups. The incidence of maternal hypotension, nausea and average ephedrine requirements in group A are higher than that in B and C groups (P<0.05). Maternal hypotension occurs mainly in5to10minutes after drug injection. At this stage, the number of maternal hypotension in group A was significantly more than that in B and C groups (P<0.05). About SPO2, Fetal Apgar score of lminute and5minutes, intra-operative transfusion amount and urine output, etc, there was no difference between the three groups. Conclusion:Prefilled Hydroxyethyl starch(130/0.4)5ml/kg can effectively improve maternal blood circulation function in the process of the waist hard joint anesthesia for cesarean section, significantly slow down and decrease the degree of low blood pressure.