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Flotrac/Vigileo?监测剖宫产患者血流动力学参数的初步研究

张媛媛1,于永浩2,王国林3   

  1. 1. 天津医科大学总医院麻醉科
    2. 天津医科大学总医院
    3. 天津医大总医院
  • 收稿日期:2011-09-02 修回日期:2011-12-08 出版日期:2012-08-15 发布日期:2012-08-15
  • 通讯作者: 张媛媛

Pilot Study of the Flotrac/Vigileo? System for Haemodynamic Parameters Monitoring in Patients Undergoing Cesarean Section

  • Received:2011-09-02 Revised:2011-12-08 Published:2012-08-15 Online:2012-08-15

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摘要： 目的：使用Flotrac/Vigileo?评价腰麻下行剖宫产手术患者心输出量和其他血流动力学参数。 方法：前瞻性研究，选取19名健康妊娠期妇女。在14个时点连续测量患者的血流动力学参数：入手术间（2个基础值），给予液体负荷后，腰麻后（4,6,8,10分钟），切皮和切子宫，新生儿娩出和胎盘娩出，子宫肌壁注射缩宫素后即刻，手术结束。观察的参数包括：心率（HR）、平均动脉压（MAP）、心输出量（CO）、心指数（CI）、每博量（SV）、每搏指数（SVI）、每搏量变异度（SVV）。 结果：腰麻后4分钟平均动脉压显著降低，腰麻平面固定后平均动脉压恢复基线水平，胎儿、胎盘娩出及注射缩宫素后心率显著增快、血压降低（P<0.05），手术结束时恢复基线水平。接受液体负荷及接受缩宫素后SVV明显降低（P<0.05），并在手术结束时恢复基础值。其他血流动力学指标无显著性变化。 结论：Flotrac/Vigileo?系统能够准确方便地监测腰麻下行择期剖宫产患者血流动力学参数变化。除了心率和平均动脉压，患者在接受液体负荷治疗后，其他血流动力学参数无显著变化。

关键词: 心输出量, 每博量, 每搏输出量变异度, 剖宫产, 腰麻, FloTrac/Vigileo?

Abstract: Objective: The aim of this study was to evaluate cardiac output and other hemodynamic measurements made using the FloTrac/VigileoTM system in patients undergoing spinal anesthesia for elective cesarean section. Methods: A prospective study enrolling 19 healthy pregnant women was performed. Hemodynamic parameters were continuously obtained at 14 main points: admission to surgery (two baseline measurements), after preload, after spinal anesthesia administration and 4 time points thereafter (4, 6, 8 and 10 min after anesthesia), at skin and uterine incision, newborn and placental delivery, oxytocin administration, end of surgery. Hemodynamic therapy was guided by mean arterial pressure, and vasopressors were used as appropriate to maintain baseline values. A repeated measures ANOVA was used for data analysis. Results: There was a significant decrease of MAP up to 4 min after spinal anesthesia (P<0.05). And heart rate increased with MAP decreased after newborn and placental delivery. Importantly, stroke volume variation decreased after preload and oxytocin administration (P< 0.05) and returned to basal values at the end of surgery. Further hemodynamic parameters showed no significant changes over time. Conclusion: No significant hemodynamic effects, except for heart rate and stroke volume changes, were observed in pregnant women managed with preload and vasopressors when undergoing elective cesarean section and spinal anesthesia.

Key words: cardic output, stroke volume, stroke volume variation, cesarean section, spinal anaesthesia, FloTrac/Vigileo?