| Objective: To investigate the continuous infusion of low-dose infusion of phenylephrine and Liquid containing colloid two cases of epidural anesthesia for cesarean section and neonatal blood hemodynamic impact, thus providing a theoretical basis for the management of obstetric anesthesia.Methods: From December 2014 to February 2015 period, in the First Affiliated Hospital of Dalian Medical University, cesarean section surgery patients(a total of 41 cases),ASA I ~ II, aged 24-40 years old, weighed 50- 100 kg of cesarean delivery at term pregnant women, with respiratory,circulation, hematological,endocrine,hepatorenal disease, pregnancy complications and contraindications to spinal anesthesia were excluded.Pregnant women were randomly divided into two groups, namely the control group(21 cases of colloid control group) and experimental group(experimental group,20 cases phenylephrine). Routine Spinal- Epidural Anesthesia anesthesia, the two groups were given 2ml 2%Lido within 20 seconds. The control group before anesthesia,pre-infusion of hydroxyethyl starch 130 / 0.4 sodium chloride injection 300 ml ~ 400 ml,adjusting for the infusion rate according to blood pressure levels, when systolic blood pressure less than 90 mm Hg and / or base value ?, injection of Ephedrine 5-10 mg.Experimental intravenous infusion of normal saline injection,only used to maintain venous access. And after given anesthesia, phenylephrine at 6μg/kg/h was pumped,then adjusted the rate of phenylephrine based on cycle indicators,and stop administration before the end surgery 20 min. Record Mean arterial pressure(MAP), heart rate(HR),stroke volume(SV), cardiac output(CO), systemic vascular resistance(SVR), thoracic fluid content(TFC), cardiac acceleration index(ACI) in entering the operating room(T0), 5 minutes after administration(T1),10 minutes after administration(T2),at the time of skin incision(T3),at the cutting uterus(T4),fetus removed(T5),5 minutes after fetus removed(T6),10 minutes after removal(T7),the end of surgery(T8) and record neonatal Apgar score. And before the first cry, clamping the umbilical cord, extract umbilical artery to analysis gas and measure lactic acid and glucose.RESULTS: When comparing the MAP,the control group was higher than the experiment group in T8,and P<0.05,the difference was statistically significant. When comparing the HR of the control group in T5, T6, T7 to T0,there was significantly reduced and P <0.05, the difference was statistically significant. The control group was higher than experimental group in T6, T7, and P <0.05,the difference was statistically significant. When comparing SV, control group was higher than the experimental group in T4, and P <0.05, the difference was statistically significant. When comparing the CO within group, the control group was higher than T0 at T5 and P <0.05, the difference was statistically significant. When comparing the ACI within group, the control group was higher than T0 at T2,T5,T6,T7 and P <0.05, the difference was statistically significant; When comparing the ACI within group, the experimental group was higher than T0 at T1, and P <0.05, the difference was statistically significant; the control group was higher than experimental group in T5 and P <0.05, the difference was statistically significant. When comparing SVR within group, two groups were lower than T0 at each time point except T6, T7, T8 in experimental group,and P <0.05,the difference was statistically significant; experimental group was higher than control group in T2,T6,and P <0.05, the difference was statistically significant. The difference was statistically significant when comparing the amount of fluid between two groups. When comparing the Umbilical artery p H between two groups, control group was lower than the experimental group, and P<0.05,the difference was statistically significant. When comparing the umbilical artery PO2, HCO3- and BE, control group was lower than experimental group, and P>0.05, there was no difference. When comparing the umbilical artery PCO2, control group was higher than experimental group and P> 0.05,there was no difference. When comparing the Umbilical artery Lactate and glucose concentrations, control group was higher than experimental group, and P<0.05 the difference were statistically significant. When comparing the Apgar between two groups,there was no difference.Conclusion: colloid prefilled could prevent and treat the hypotension of Spinal-Epidural Anesthesia, but it can aggravate cardiac preload and increase cardiac work, resulting in increased myocardial oxygen consumption. Phenylephrine can maintain maternal circulation stable without increasing cardiac work, and can improve the umbilical artery lactic acid, p H. |
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