Effect Of Different Postures On Hemodynamics And Anesthesia Block Plane In Cesarean Section

Objective:1.To observe the effect of postural adjustment on the prevention of supine hypotension syndrome in cesarean section.2.To explore the best position to reduce the incidence of hypotension,phenylephrine dosage and nausea and vomiting during cesarean section.3.To observe the influence of different body positions on anesthesia block plane.MethodS:120 cases of puerpera cesarean section aged 20-40 years and weighing 60-90 kg in linzi district maternal and child health care hospital of zibo city from January 2019 to July 2019 were selected.The patients were randomly divided into three groups according to different body positions,with 40 cases in each group.After the puerpera enters the room,it is connected to the non-invasive hemodynamic monitoring system?Anesthesia puncture was performed in the right lateral position,and The operating bed was performed in the horizontal position at 0° Angle ? Epidural puncture was performed in 3?4 lumbar Spaces,place lumbar hemp needle after success,after cerebrospinal fluid reflux was unobstructed,slowly inject 0.5% heavy ropivacaine lumbar anaesthetic fluid,then place the epidural catheter,and lie down on the operating bed after fixation.The parturient in group D lay horizontally on the operating bed(horizontal position of the operating bed);The parturient in group L lay horizontally on the operating bed,which tilted 20° to the left and drove the parturient's whole body to tilt 20° to the left;The parturients in the DR group were placed horizontally on the operating bed(horizontal position of the operating bed),and A wedge was placed on their right buttocks to make the whole buttocks at an Angle of 20°from the horizontal position.When the maternal systolic blood pressure of the three groups was lower than 100 mmHg,phenylephrine was injected intravenously for 100ug/ time until the maternal systolic blood pressure was maintained above 100 mmHg,intravenous injection of phenylephrine can easily cause the heart rate to slow down,when the heart rate is lower than 60 beats/hour,intravenous injection of atropine 0.5mg.The changes of hemodynamic parameters of the three groups of pregnant women were observed and recorded at each time point,and the number of cases of hypotension,amount of noradrenaline,and adverse reactions(nausea and vomiting,lower limb paresthesia)in the three groups were recorded.And the intraoperative infusion volume,urine volume,operation time,bleeding volume,preoperative anesthesia plane,postoperative anesthesia plane,measured fetal weight were recorded.Result:1.There was no significant difference in age,height,weight,gestational age and hemoglobin between the three groups(p>.05).There was no statistically significant difference between the predicted and measured fetal weight between the three groups(p>0.05).2.Comparison of hemodynamics among three groups of parturient women:Systolic blood pressure immediately after anaesthesia and 1 minute after anaesthesia were turned over,the right buttock padding group was higher than the left leaning group and supine group,with significant statistical difference(p<0.05).The heart rate 1 minute ? 3 minute after anaesthesia were turned over was higher in the left leaning group than in the horizontal lying group and the right buttock padding group,with significant statistical difference(p<0.05).The peripheral circulation resistance immediately after the anesthesia and 1 minute after the anesthesia was turned over,the right buttock padding group was lower than the left leaning group and supine group,with significant statistical difference(p<0.05).Compare within groups : Systolic blood pressure,diastolic blood pressure,mean arterial pressure,cardiac output,stroke volume and peripheral vascular resistance showed significant statistical differences between the baseline values after delivery and those before anesthesia(p<0.05).Pulse rate before membrane rupture was significantly lower than that before anesthesia,and there was a significant statistical difference(p<0.05).The variation rate of pulse pressure difference from immediately after anesthesia to after delivery was significantly higher than that before anesthesia(p<0.05).3.At the time points of 1 minute,3 minutes and 5 minutes after turning over under anesthesia,the number of cases of hypotension in group D was more than that in group L and group DR,and group L was more than that in group DR,with statistical differences among the three groups(p<0.05).4.The dosage of phenylephrine and the number of adverse reactions of nausea and vomiting in the three groups were compared,the right buttock pad group was less than the left-leaning group and the horizontal recumbent group,there was a statistical difference(p<0.05).There was no significant difference in infusion volume,blood loss,urine volume and operation time(p>.05).5.The group with right buttock pad on the upper boundary of anesthesia block plane was higher than the group with left leaning and horizontal decubitus on the operating bed before operation after anesthesia,postoperative anesthesia block plane upper boundary right buttock pad group was lower than the left leaning group and horizontal recumbent group,There was a statistical difference(p<0.05).Conclusion:The effect of postural adjustment on the reduction of the incidence of supine hypotension syndrome in cesarean section is definite.In reducing the use of phenylephrine and the incidence of adverse reactions to nausea and vomiting,the right hip pad group had the best effect compared to the left-leaning group and the horizontal recumbent group.The postoperative block level of the right buttock pad group subsided faster,which was beneficial to the recovery of gastrointestinal function and worthy of clinical promotion.