重度妊高征持续性硬膜外麻醉剖宫产血压变化的临床分析

目的 :了解重度妊高征持续性硬膜外麻醉下剖宫产时的血压变化规律。方法 :选择重度妊高征孕妇和正常孕妇各 1 0 2例 ,比较持续性硬膜外麻醉下剖宫产术前、术中最低、麻醉后、术后的血压变化及术中输液量。结果 :麻醉后妊高征组与对照组的最低血压及麻醉后血压均较麻醉前血压显著降低 (P<0 .0 1 ) ;血压下降幅度妊高征组显著大于对照组 (P<0 .0 1 ) ;术中输液量妊高征组显著高于对照组 (P<0 .0 5) ;两组最低血压中舒张压相近 (P>0 .0 5) ;术后血压回升稍高于麻醉前血压。结论 :持续性硬膜外麻醉能够暂时解除血管痉挛及降低血管的紧张度 ,使血压下降 ;术后血管紧张度恢复及术中输液 ,造成术后有效循环血容量相对增加 ,致使血压回升 ,诱发子痫。

THE CHANGES OF BLOOD PRESSURE DURING CESAREAN SECTION UNDER CONTINUAL EPIDURAL ANESTHESIA IN WOMEN WITH SEVERE PREGNANCY-INDUCED HYPERTENSION

Objective:To investigate changes of blood pressure during cesarean section under continual epidural anesthesia in women with severe pregnancy induced hypertension(PIH).Methods:102 cases of severe PIH women and normal pregnant women were selected respectively.To compare the blood pressure changes under continual epidural anesthesia before operation,during operation,after anesthesia,and after operation respectively,and change of infusion fluid volume during operation.Results:The lowest blood pressure under anesthesia and the postanesthetic blood pressure in PIH group and the normal group were all lower compared with the blood pressure before anesthesia( P <0 01);The degree of blood pressure decline in PIH group was much more obvious than that of the normal group( P <0 01);The infusion volume during operation in PIH group was much larger than that of the normal group( P <0 05).The diastolics of the lowest blood pressure in the two groups were similar( P >0 05).The blood pressure picked up after operation was slightly higher than that before anesthexia.Conclusion:Continual epidural anesthesia can lower blood pressure by relieving blood vessel spasm and decreasing tension of blood vessel temporarily.The restoring of blood vessel tension after operation and the fluid infusion during operation can cause relative increase of effective circulation blood volume and picking up of the blood pressure which can induce eclampsia.