| Objective:To study whether goal-directed fluid therapy can reduce the incidence of hypotension,nausea and vomiting,the dosage of phenylephrine of parturients before delivery and the incidence of neonatal adverse events in cesarean section in the context of colloid preloaded and prophylactic pumping of phenylephrine.Methods:80 women who underwent elective cesarean section,ASA = grade 2,were randomly divided into 2 groups:Goal-directed fluid therapy(G group,n =40),Control group(group C,n=40).500 ml hydroxyethyl starch solution was given before anesthesia in both groups.Monitored the hemodynamic parameters of parturients before and after the infusion with CNAP and recorded the average value of them(TO time point).Then we began to implement spinal anesthesia.Once the local anesthetic was injected into the subarachnoid space,the intravenous infusion of phenylephrine was performed at a rate of 25 ?g/min.After completing the spinal anesthesia,we assisted the parturients to shift to the supine position,tilted the operating table to the left by 30 degrees,and immediately recorded the hemodynamic parameters of the patient at this time,namely the parameters at the time point of T1.Then the intervention group(Group G)was given compound sodium chloride solution 3 ml/kg within 3 min as one bolus,according to the maternal ideal weight(height cm-110kg).And the hemodynamic parameters of parturients were recorded after first bolus.If the increase of SV was more than 10%,we gave 3 ml/kg compound sodiLum chloride solution again as another bolus within 3 minutes and repeated this process until the increase value of SV<10%.After that,the compound sodium chloride solution was given at a constant rate of 2 ml/kg/h.In the control group(Group C),parturients were given compound sodium chloride solution at a constant rate of 2 ml/kg/h without any bolus.Paid close attention to and recorded the maternal vital signs throughout the procedure.If the maternal blood pressure after anesthesia was higher than the base blood pressure value,we could lower the pump speed of phenylephrine appropriately.If hypotension occured after anesthesia,phenylephrine was continuously pumped at a speed of 25 ig/min,and an additional 100 ?g phenylephrine was given at the same time,which could be repeated according to the maternal blood pressure.Hemodynamic parameters were recorded at 4 min(T2),7 min(T3),10 min(T4)and 15 min(T5)after anesthesia.Stopped the intervention after delivering,and recorded whether the parturients had hypotension,nausea or vomiting,and the amount of vasoactive drlugs and fluid volume used.Apgar scores were recorded Imin and 5min after delivery,and maternal hemodynamic parameters were recorded 1 min(T6)and 5 min(T7)after delivery.At the end of surgery(T8),maternal hemodynamic parameters,total fluid dosage,total vasoactive dr?g dosage,and neonatal adverse events were recordedResults:25%(10/40)of the G group had hypotension before delivery,and 32.5%(13/40)of the C group had hypotension before delivery,with no significant difference between two groups(x2 = 0.549,P = 0.459).There was no statistic difference between the G group and the C group in the amount of phenylephrine before delivery(t = 0.129,P = 0.898)and the total amount of phenylephrine during surgery(t = 0.230,P= 0.819).The incidence of nausea and vomiting before delivery was 10%(4/40)in the G group,and 2.5%(1/40)in the C group,with no statistic difference between the two groups(x2=1.920,P=0.359).In the C group,1 newborn's 1 min Apgar score<7,and all newborns,5 min Apgar scores>7.There was no significant difference between the G group and the C group in 1 min Apgar score(P = 0.376)and 5 min Apgar score(P = 0.317).Neonatal intubation rate was 5%(2/40)in the C group and 2.5%(1/40)in the G group,and there was no significant difference between the two groups(x2 = 0.346,P= 1.000).The NICU transfer rate of the control group was 7.5%(3/40),and that of the G group was 2.5%(1/40).There was no significant difference between the two groups(x2= 1.053,P =0.615).There were statistic differences in systolic blood pressure(P ? 0.008),diastolic blood pressure(P = 0.034)and mean arterial pressure(P ? 0.040)between the two groups 10 min after anesthesia(T4).These three values were higher in the G group than in the C group with significant difference,while at T4 the difference between the other hemodynamic parameters was not statistically significant(P>0.05).There was also no statistic difference in hemodynamic parameters between the two groups at other time points(P>0.05).Conclusion:In the context of preoperative administration of 500 ml hydroxyethyl starch and prophylactic pumping of phenylephrine at a rate of 25?g/min immediately after spinal anesthesia,goal-directed fluid therapy could not reduce the incidence of hypotension,nausea and vomiting before delivery,or reduce the dosage of phenylephrine or improve the outcome of neonates.However,the applicability of goal-directed fluid therapy in high-risk parturients(ASA)grade 3)needs further study. |
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