腹式呼吸操对腰麻剖宫产产妇发生仰卧位低血压综合征及胎儿的影响

doi:10.11958/20240288

天津医药 ›› 2024, Vol. 52 ›› Issue (10): 1084-1088.doi: 10.11958/20240288

腹式呼吸操对腰麻剖宫产产妇发生仰卧位低血压综合征及胎儿的影响

蔡军¹(), 秦晗², 颜建娥¹

1 扬州大学附属连云港市妇幼保健院麻醉科（邮编222006）
2 徐州医科大学附属连云港医院儿童口腔科

收稿日期:2024-03-11 修回日期:2024-05-29 出版日期:2024-10-15 发布日期:2024-10-14
作者简介:蔡军（1974），男，主任医师，主要从事小儿全身麻醉深度监测与调控、产科高风险麻醉管理等方面研究。E-mail：lygsy2003@163.com
基金资助:
连云港市妇幼健康科研项目(F202306);连云港市卫生健康委科研项目(202225)

Effects of 3-2-3 abdominal breathing exercises on supine hypotension syndrome and fetus after subarachnoid block in caesarean section parturients

CAI Jun¹(), QIN Han², YAN Jian'e¹

1 Department of Anesthesiology, Lianyungang Maternal and Child Health Hospital Affiliated to Yangzhou University, Lianyungang 222006, China
2 Pediatric Department of Stomatology, the Lianyungang Affiliated Hospital of Xuzhou Medical University

Received:2024-03-11 Revised:2024-05-29 Published:2024-10-15 Online:2024-10-14

蔡军, 秦晗, 颜建娥. 腹式呼吸操对腰麻剖宫产产妇发生仰卧位低血压综合征及胎儿的影响[J]. 天津医药, 2024, 52(10): 1084-1088.

CAI Jun, QIN Han, YAN Jian'e. Effects of 3-2-3 abdominal breathing exercises on supine hypotension syndrome and fetus after subarachnoid block in caesarean section parturients[J]. Tianjin Medical Journal, 2024, 52(10): 1084-1088.

摘要/Abstract

摘要：

目的探讨3-2-3腹式呼吸操对腰麻后剖宫产产妇发生仰卧位低血压综合征（SHS）及胎儿的影响。方法将131例剖宫产产妇用随机数字表法分为对照组44例、腹式深呼吸组（深呼吸组）43例和3-2-3腹式呼吸操组（3-2-3组）44例。腰麻后平卧，对照组无干预；深呼吸组行深呼吸鼓腹；3-2-3组按吸气计数1、2、3腹部鼓至最高，屏气计数1、2，再呼气计数1、2、3至腹部降至最低方式呼吸。记录3组麻醉前（T₀）、麻醉后仰卧5 min（T₁）、手术前即刻（T₂）、胎儿娩出前（T₃）、胎儿娩出后（T₄）的心率（HR）和T₀、T₁时收缩压（SBP）、平均动脉压（MAP）变化；比较3组产妇不良反应发生率、升压药使用率、SHS发生率、呼吸坚持时长及新生儿1 min、5 min的Apgar评分。采集脐动脉血并检测白细胞介素（IL）-1、IL-6、肿瘤坏死因子α（TNF-α）、皮质醇（Cor）、去甲肾上腺素（NE）、pH值、乳酸（Lac）、碱剩余（BE）等指标。结果（1）对照组T₁—T₄时、深呼吸组T₁和T₃时HR较T₀时变化明显（P<0.05），3-2-3组T₁—T₄时HR较对照组波动减小（P<0.05）；T₁时对照组、深呼吸组的SBP和MAP较T₀时下降（P<0.05），而3-2-3组MAP无明显改变（P>0.05）。（2）与对照组比较，3-2-3组不良反应和SHS发生率、升压药使用率下降，新生儿Apgar评分增高；3-2-3组呼吸坚持时长较深呼吸组和对照组延长（P<0.05）。（3）与对照组相比，3-2-3组脐动脉血IL-1、IL-6、TNF-α、Cor、NE、pH值、Lac、BE均明显改善（P<0.05）；与深呼吸组相比，3-2-3组IL-6、TNF-α、pH值、Lac、BE有明显差异（P<0.05）。结论以3-2-3腹式呼吸操指导腰麻后剖宫产产妇可降低SHS发生率，抑制胎儿应激反应和酸中毒，优于腹式深呼吸法。

关键词: 剖宫产术, 麻醉, 腰麻, 3-2-3腹式呼吸, 仰卧位低血压综合征

Abstract:

Objective To discuss the effect of 3-2-3 abdominal breathing exercises on the occurrence of supine hypotension syndrome (SHS) and fetus in women with caesarean section after subarachnoid block. Methods A total of 131 cesarean section women were selected and randomly divided into three groups: the control group, the deep breathing group and the 3-2-3 abdominal breathing exercise group (3-2-3 group), with 44, 43 and 44 cases in each group. After subarachnoid block, the postpartum women were lied flat and received the following treatment: the control group received no intervention, the deep breathing group only instructed deep breathing and abdominal distension and in the 3-2-3 group inhalation counted 1, 2 and 3 with abdominal bulge to the highest, holding counts 1, 2 and with exhalation counted 1, 2 and 3 until the abdomen reaches the lowest. Changes of heart rates (HR) before anesthesia (T₀), supine position for 5 minutes after anesthesia (T₁), immediately before surgery (T₂), before fetal removal (T₃), after fetal removal (T₄), as well as systolic blood pressure (SBP), mean arterial pressure (MAP) at T₀ and T₁ were recorded in the three groups. The occurrence of adverse reactions, the use rate of vasopressors, incidence of SHS, duration of respiratory persistence and Apgar scores of 1-minute and 5-minute in newborns were compared between the three groups. Umbilical artery blood was collected, and interleukin (IL)-1,IL-6 and tumor necrosis factor alpha (TNF-α), cortisol (Cor), norepinephrine (NE), pH value, lactate (Lac) and buffuer excess (BE) were detected. Results (1) Compared to the control group，the HR at T₁to T₄showed significant changes in the deep breathing group (P<0.05), while the HR at T₁ to T₄ of the 3-2-3 group showed less fluctuation compared to the control group (P<0.05). SBP and MAP of the control group and the deep breathing group significantly decreased at T₁ (P<0.05), but there was no significant change in MAP in the 3-2-3 group (P>0.05). (2) Compared with the control group, the incidence of adverse reactions and SHS, as well as the use of vasopressors decreased obviously in the 3-2-3 group (P<0.05), and Apgar score of newborns increased (P<0.05). The respiratory persistence duration was longer in the 3-2-3 group than that in the deep breathing group and the control group (P<0.05). (3) Compared to the control group, there were significant improvements in IL-1, IL-6, TNF-α, Cor, NE, pH, Lac and BE in the 3-2-3 group (all P<0.05). Compared to the deep breathing group, there were significant differences in IL-6, TNF-α, pH value, Lac and BE in the 3-2-3 groups (P<0.05). Conclusion The 3-2-3 abdominal breathing exercises can reduce the incidence of SHS, inhibit fetal stress response and acidosis, and is superior to abdominal deep breathing method in women with cesarean section after subarachnoid block.

Key words: cesarean section, anesthesia, subarachnoid block, 3-2-3 abdominal breathing, supine hypotension syndrome

中图分类号:

R719.8，R614.41

图/表 6

参考文献 20

[1]	HUMPHRIES A, MIRJALILI S A, TARR G P, et al. Hemodynamic changes in women with symptoms of supine hypotensive syndrome[J]. Acta Obstet Gynecol Scand, 2020, 99(5):631-636. doi:10.1111/aogs.13789.
[2]	MASSOTH C, CHAPPELL D, KRANKE P, et al. Supine hypotensive syndrome of pregnancy:a review of current knowledge[J]. Eur J Anaesthesiol, 2022, 39(3):236-243. doi:10.1097/EJA.0000000000001554.
[3]	GOMMEZ N A G, WARREN N, LABKO Y, et al. Intrathecal opioid dosing during spinal anesthesia for cesarean section:an integrative review[J]. J DrNursPract, 2020, 13(2):108-119. doi:10.1891/JDNP-D-19-00025.
[4]	HUGHES E J, PRICE A N, MCCABE L, et al. The effect of maternal position on venous return for pregnant women during MRI[J]. NMR Biomed, 2021, 34(4):e4475. doi:10.1002/nbm.4475.
[5]	AHMED A, RUZIEH M, KANJWAL S, et al. Syndrome of supine hypertension with orthostatic hypotension:pathophysiology and clinical approach[J]. Curr Cardiol Rev, 2020, 16(1):48-54. doi:10.2174/1573403X15666190617095032.
[6]	XIAO T, LI W, YU M, et al. The effect of various pressure of pneumatic uterine bracket by using sacculesterine external stent on incidence of supine hypotensive syndrome[J]. Ginekol Pol, 2021, 92(7):505-511. doi:10.5603/GP.a2021.0009.
[7]	章凤强. 腹式深呼吸在剖宫产手术中仰卧位低血压中的防治应用[J]. 临床合理用药杂志, 2012, 5(24):117.
	ZHANG F Q. The application of abdominal deep breathing in the prevention and treatment of supine hypotension during cesarean section[J]. Journal of Clinical Rational Medication, 2012, 5(24):117. doi:10.3969/j.issn.1674-3296.2012.24.091.
[8]	SHABAN M, RAZA S E A, HASSAN M, et al. A digital score of tumour-associated stroma infiltrating lymphocytes predicts survival in head and neck squamous cell carcinoma[J]. J Pathol, 2022, 256(2):174-185. doi:10.1002/path.5819.
[9]	崔红丽, 吴雅峰, 李雁平. 超声心动图对妊娠中晚期下腔静脉压迫综合征的诊断价值[J]. 中华医学超声杂志(电子版), 2020, 17(9):880-884.
	CUI H L, WU Y F, LI Y P. The diagnostic value of echocardiography in inferior vena cava compression syndrome in the second and third trimester of pregnancy[J]. J Chinese Medical Ultrasound(electronic version), 2020, 17(9):880-884. doi:10.3877/cma.j.issn.1672-6448.2020.09.011.
[10]	陈果, 胡丰登, 陈晓丽, 等. 变换体位平均动脉压差对剖宫产腰硬联合麻醉术中仰卧位低血压综合征的预测价值[J]. 中国妇幼保健, 2021, 36(7):1694-1696.
	CHEN G, HU F D, CHEN X L, et al. The predictive value of postural mean arterial pressure difference in supine hypotension syndrome during combined spinal-epidural anesthesia for cesarean section[J]. Matern Child Health Care China, 2021, 36(7):1694-1696. doi:10.19829/j.zgfybj.issn.1001-4411.2021.07.074.
[11]	ZHANG Y, XIAO F, ZHANG W. Intravenous ondansetron for the prevention of supine hypotensive syndrome during spinal anesthesia for cesarean section:a randomized controlled trial[J]. Front Pharmacol, 2024, 15:1194196. doi:10.3389/fphar.2024.1194196.
[12]	MASSOTH C, TÖPEL L, WENK M. Hypotension after spinal anesthesia for cesarean section:how to approach the iatrogenic sympathectomy[J]. Curr Opin Anaesthesiol, 2020, 33(3):291-298. doi:10.1097/ACO.0000000000000848.
[13]	CAI S, DAI R, MI J, et al. Perioperative management of a patient with a giant ovarian tumor:a case report[J]. Medicine (Baltimore), 2020, 99(41):e22625. doi:10.1097/MD.0000000000022625.
[14]	杜唯佳, 徐振东, 刘志强, 等. 剖宫产腰麻后低血压预测方法的研究进展[J]. 临床麻醉学杂志, 2019, 35(2):192-194.
	DU W J, XU Z D, LIU Z Q, et al. Research progress on prediction methods of hypotension after spinal anesthesia for cesarean section[J]. J Clin Anesthesiology, 2019, 35(2):192-194. doi:10.12089/jca.2019.02.022.
[15]	牛鹏飞, 孙铭阳, 李宁涛, 等. 产妇腰麻后发生仰卧位低血压综合征的危险因素及其预测模型[J]. 中华麻醉学杂志, 2023, 43(11):1311-1315.
	NIU P F, SUN M Y, LI N T, et al. Risk factors for supine hypotension syndrome after cesarean section and development of a prediction model in parturients[J]. J Chinese Anesthesiology, 2023, 43(11):1311-1315. doi:10.3760/cma.j.cn131073.20230707.01107.
[16]	耿志宇, 王东信, 杨慧霞. 《产科麻醉和围产医学会加速剖宫产术后康复共识声明和推荐》解读[J]. 北京医学, 2022, 44(6):547-550.
	GENG Z Y, WANG D X, YANG H X. Interpretation of "Society of obstetric anesthesia and perinatology medicine consensus statement and recommendations on accelerating recovery after Cesarean section"[J]. Beijing Medicine, 2022, 44(6):547-550. doi:10.15932/j.0253-9713.2022.06.040.
[17]	EHRHARDT H, AUBERT A M, ÅDEN U, et al. EPICE-SHIPS Research Group. Apgar score and neurodevelopmental outcomes at age 5 years in infants born extremely preterm[J]. JAMA Netw Open, 2023, 6(9):e2332413. doi:10.1001/jamanetworkopen.2023.32413.
[18]	崔明珠, 牛鹏飞, 阮孝国, 等. 新型子宫托架对蛛网膜下腔麻醉剖宫产产妇及新生儿的影响[J]. 中华实用诊断与治疗杂志, 2020, 34(6):588-591.
	CUI M Z, NIU P F, RUAN X G, et al. Effect of a new type of uterine bracket on parturient and neonate during subarachnoid anesthesia for cesarean delivery[J]. Journal of Chinese Practical Diagnosis and Therapy, 2020, 34(6):588-591. doi:10.13507/j.issn.1674-3474.2020.06.013.
[19]	卢旭俊, 王文革, 杨云月, 等. 脐带血IL-36γ水平与早期婴儿湿疹的关系分析[J]. 天津医药, 2023, 51(12):1356-1360.
	LU X J, WANG W G, YANG Y Y, et al. Analysis of the relationship between IL-36γ level in umbilical cord blood and early infant eczema[J]. Tianjin Med J, 2023, 51(12):1356-1360. doi:10.11958/20230643.
[20]	BEDELL S, HUTSON J, DE VRIJER B, et al. Effects of maternal obesity and gestational diabetes mellitus on the placenta:current knowledge and targets for therapeutic interventions[J]. Curr Vasc Pharmacol, 2021, 19(2):176-192. doi:10.2174/1570161118666200616144512.

组别		n	年龄/岁		BMI/（kg/m²）			手术时长/min
对照组		44	28.32±4.10		30.81±3.42			43.55±5.53
深呼吸组		43	27.51±4.41		29.86±4.42			44.87±4.98
3-2-3组		44	27.53±4.04		29.45±2.70			45.01±5.31
F			0.232		1.128			0.231
组别	孕龄/周			初产		麻醉平面
组别	孕龄/周			初产		T6	T8		T10
对照组	38.12±1.52			32（72.7）		8（18.2）	33（75.0）		3（6.8）
深呼吸组	38.55±0.98			33（76.7）		4（9.3）	37（86.0）		2（4.7）
3-2-3组	37.97±1.02			31（70.4）		7（15.9）	34（77.3）		3（6.8）
F或χ²	0.750			0.450		1.866

组别		n	年龄/岁		BMI/（kg/m²）			手术时长/min
对照组		44	28.32±4.10		30.81±3.42			43.55±5.53
深呼吸组		43	27.51±4.41		29.86±4.42			44.87±4.98
3-2-3组		44	27.53±4.04		29.45±2.70			45.01±5.31
F			0.232		1.128			0.231
组别	孕龄/周			初产		麻醉平面
组别	孕龄/周			初产		T6	T8		T10
对照组	38.12±1.52			32（72.7）		8（18.2）	33（75.0）		3（6.8）
深呼吸组	38.55±0.98			33（76.7）		4（9.3）	37（86.0）		2（4.7）
3-2-3组	37.97±1.02			31（70.4）		7（15.9）	34（77.3）		3（6.8）
F或χ²	0.750			0.450		1.866

组别	n		T₀	T₁	T₂
对照组	44		81.23±7.88	90.47±12.71^A	74.03±9.91^A
深呼吸组	43		80.90±6.57	85.50±8.71^A	81.20±10.73^a
3-2-3组	44		84.16±10.10	81.70±8.99^a	79.61±7.57^Aa
F			1.278	6.512^＊＊	4.505^＊
组别		T₃		T₄		F
对照组		93.86±12.53^A		91.76±10.24^A		19.111^＊＊
深呼吸组		90.41±10.43^A		83.62±10.22^a		6.411^＊＊
3-2-3组		82.36±8.73^ab		81.11±9.68^a		1.237
F		8.844^＊＊		8.909^＊＊

组别	n		T₀	T₁	T₂
对照组	44		81.23±7.88	90.47±12.71^A	74.03±9.91^A
深呼吸组	43		80.90±6.57	85.50±8.71^A	81.20±10.73^a
3-2-3组	44		84.16±10.10	81.70±8.99^a	79.61±7.57^Aa
F			1.278	6.512^＊＊	4.505^＊
组别		T₃		T₄		F
对照组		93.86±12.53^A		91.76±10.24^A		19.111^＊＊
深呼吸组		90.41±10.43^A		83.62±10.22^a		6.411^＊＊
3-2-3组		82.36±8.73^ab		81.11±9.68^a		1.237
F		8.844^＊＊		8.909^＊＊

组别	n		SBP/mmHg
组别	n		T₀		T₁		t
对照组	44		122.86±10.65		102.06±12.46		12.582^＊＊
深呼吸组	43		121.16±9.93		107.86±7.70^a		11.505^＊＊
3-2-3组	44		122.10±10.53		113.14±7.57^a		7.577^＊＊
F			0.015		22.068^＊＊
组别		MAP/mmHg
组别		T₀		T₁		t
对照组		66.70±5.22		55.06±5.01		11.884^＊＊
深呼吸组		66.86±5.64		59.90±4.12^a		7.332^＊＊
3-2-3组		68.16±3.35		66.83±4.21^a		2.026
F		0.876		51.455^＊＊

腹式呼吸操对腰麻剖宫产产妇发生仰卧位低血压综合征及胎儿的影响

Effects of 3-2-3 abdominal breathing exercises on supine hypotension syndrome and fetus after subarachnoid block in caesarean section parturients

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组别	n	不良反应	升压药	呼吸坚持时长/min	SHS
对照组	44	16（36.3）	11（25.0）	1.66±0.61	17（38.6）
深呼吸组	43	8（18.6）	5（11.6）	2.23±0.37^a	11（25.6）
3-2-3组	44	4（9.1）^a	2（4.5）^a	4.31±0.67^ab	5（11.3）^a
χ²或F		10.029^＊＊	8.007^＊	50.926^＊＊	8.688^＊

组别	n	Apgar评分/分			转科治疗
组别	n	1 min	5 min	t	转科治疗
对照组	44	9.31±0.95	9.64±0.75	1.730	12（27.1）
深呼吸组	43	9.57±0.83	9.78±0.54	1.295	8（18.6）
3-2-3组	44	9.82±0.47^a	9.92±0.25^a	1.362	3（7.8）^a
F或χ²		4.251^＊	3.652^＊		6.408^＊

组别	n	炎性因子					血气分析
组别	n	IL-1/（μg/L）	IL-6/（ng/L）	TNF-α/（μg/L）	Cor/（μg/L）	NE/（μg/L）	pH值	Lac/（mmol/L）	BE
对照组	44	5.87±1.28	12.36±1.37	48.77±4.67	213.22±19.67	87.71±12.21	7.26±0.03	2.56±0.35	-3.93±0.54
深呼吸组	43	4.41±1.09^a	9.97±1.28^a	41.27±4.91^a	197.63±21.26	62.23±11.89^a	7.29±0.02	2.29±0.35	-3.37±0.46
3-2-3组	44	4.37±1.16^a	8.77±1.35^ab	33.76±5.24^ab	175.53±18.35^a	59.77±12.03^a	7.36±0.03^ab	1.73±0.29^ab	-2.23±0.69^ab
F		281.951^＊＊	235.285^＊＊	30.274^＊＊	3.505	17.791^＊＊	26.266^＊＊	10.475^＊＊	20.723^＊＊

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