| Objective:To observe the predictive effect of inferior vena cava collapse index on the occurrence of supine hypotension syndrome in parturients after spinal anesthesia,and to evaluate the preventive effect of a new uterine bracket(patent number ZL 201820087686.6)on SHS in parturients undergoing cesarean section after spinal anesthesia.Methods:1.Prediction of SHS in parturients after spinal anesthesia:Observation of 60 women with elective cesarean section were divided into 2 groups(n=30)according to whether SHS occurred:SHS group(group S)and non-SHS group(group W).The two groups were recorded in supine position(T0),30 0 on the left side of the operating table(T1),after spinal anesthesia(T2),and HR,SBP,DBP,and IVC inner diameter at T0 to T2 in group S The maximum value(IVC max)and minimum value(IVC min)were calculated,and the inferior vena cava collapse index(cIVC)was calculated.To evaluate the correlation between the cIVC difference between T1 and T0(?cIVC)and the occurrence of SHS after spinal anesthesia.2.The effect of a new type of uterine bracket on preventing SHS after spinal anesthesia:60 parturients undergoing elective cesarean section,aged 20-40 years,ASA grade I or?,BMI 18.5?30.0 kg/m2,pregnancy 37-42 weeks,obstetrical ultrasound showed singleton,randomly divided into two groups(nude 30):uterine bracket group(group Z)and postural group(group T).After entering the room,the patients were treated with intravenous indwelling needle,routine mask oxygen inhalation,spinal anesthesia under the right lying position,and immediately after injection,the patients were placed with a new uterine bracket in group Z,and the operating bed in group T tilted 30°to the left.When the acupuncture sensation level reached T6,the operation began.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),heart rate(HR)and finger pulse oxygen saturation(SpO2)were recorded in supine position before anesthesia(T1),intervention after spinal anesthesia(T2),5 min after spinal anesthesia(T3),fetal delivery(T4)and end of operation(T5).The maximum(IVCmax)and minimum(IVC min)of inferior vena cava(IVC)at T1,T2 and T3 were measured by ultrasound,and the collapse index of inferior vena cava(cIVC)was calculated to record.The values of PH,PO2,PCO2 and BE in umbilical artery and umbilical vein blood were recorded.The Apgar scores of 1 min,5 min and 10 min after delivery were recordedResult:1.Experiment one1.1 There was no statistically significant difference in general data within the group(P>0.05)1.2 Compared with T0,the HR in the two groups was significantly slower and the SBP and DBP were significantly higher in T1.The HR in the two groups was significantly faster and the SBP and DBP were significantly lower at T2.At T1,the SBP and DBP of the group W were significantly higher than those of the group S,and at T2,the SBP and DBP of the group W were significantly higher than those of the group S(P<0.05)1.3 At T1 and T2,the IVC max and IVC min of the group S were significantly higher than those of the group W,and cIVC was significantly higher than that of the W group(P<0.05)1.4 In group S,there was a linear negative correlation between cIVC and TBP at T0,T1,and T2.The correlation indexes were r=-0.37(P=0.033),r=-0.44(P=0.010),and r=-0.38(P=0.032)1.5 According to the ROC curve,the maximum value of the Jordan index is 0.467,the sensitivity is 66.7%,and the specificity is 80.0%.The corresponding optimal cutoff value is 0.75mm.2.Experiment two2.1 There was no significant difference in maternal age,body mass index,ASA grade,gestational age,biparietal diameter,head circumference,estimated weight,operation time,transfusion volume,bleeding volume,time from lumbar anesthesia to skin incision and time from skin incision to fetus extraction between the two groups2.2 There was no significant difference in HR and SpO2 between the two groups(P>0.05).The SBP of Z group was significantly higher than that of T group at T 2,T3 and T5,the DBP of Z group was significantly higher than that of T group at T3 and T5,and the MAP of Z group was significantly higher than that of T group at T3(P<0.05)2.3 There was no significant difference in IVC max,IVCmin and cIVC between the two groups at T1(P>0.05).The cIVC in group Z was significantly lower than that in group T at T2 and T3,while the levels of IVC max and IVC min in group Z were significantly higher than those in group T at T2 and T3,while the IVCmax and IVCmin in group Z were significantly higher than those in group T1,and the levels of IVC max and IVCmin in group T2 were significantly higher than those in group T1.IVCmax and IVCmin in group T3 were significantly lower than those in group T1(P<0 05)2.4 There were 11 cases of nausea and vomiting in group T,with the incidence of 36.7%.However none of the puerperas feels nausea and vomiting in group Z.There were 17 cases with hypotension in group T,with the incidence of 56.7%.Compare with 1 case with hypotension in group Z,with the incidence of 3.3%,difference between the two groups was statistic ally signific ant(P<0.05)2.5 The PH and PO2 of umbilical artery blood gas in group Z were higher than those in group T,but the negative value of BE in group Z was lower than that in group T.The umbilical vein blood gas PH and PO2 in group Z were higher than that in group T,while the negative value of BE in group Z was lower than that in group T(P<0.05).There was no significant difference in PCO2 of umbilical artery and umbilical vein between the two groups(P>0.05)2.6 The average 1 min Apgar score and 5 min Apgar score of group Z were 9.9±0.3 and 10.0±0.0,respectively,while those of group T were 8.3±0.7 and 8.9±0.3,respectively There was significant difference between the two groups(P<0.05).There was no significant difference in 10 min Apgar score between the two groups(P> 0.05).Conclusion: The difference of inferior vena cava collapse index before and after postural change can predict the occurrence of SHS after lumbar anesthesia,and the new uterine bracket can effectively prevent the occurrence of SHS after spinal anesthesia. |
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