陈培 刘兰 钟泰迪 门鑫 程梅

[摘要] 目的 分析剖宮产蛛网膜下腔阻滞产妇发生低血压的相关因素，为防治低血压提供参考。 方法 回顾性分析2018年1—12月杭州市妇产科医院320例在蛛网膜下腔阻滞下行子宫下段横切口剖宫产产妇的临床资料，分析阻滞后发生低血压的相关因素以及处理情况，并采用Logistic回归分析筛选发生低血压的危险因素（产妇因素、胎儿因素、麻醉因素、体位因素和Bezold-Jarisch反射）。 结果 320例产妇发生低血压143例（44.69%），其中95例（66.43%）单次静脉注射麻黄碱10 mg纠正低血压，48例（33.57%）多次静脉注射麻黄碱10 mg纠正低血压。Logistic回归分析结果表明，宫高>36 cm、巨大儿、多胎妊娠、体质量指数（BMI）≥28 kg/m2、阻滞平面≥T6、注药速度≤10 s、仰卧位、Bezold-Jarisch反射是蛛网膜下腔阻滞后发生低血压的危险因素（P<0.05），其中巨大儿、多胎妊娠、BMI≥28 kg/m2、阻滞平面≥T6、注药速度≤10 s、仰卧位、Bezold-Jarisch反射是需多次注射麻黄碱才能纠正低血压的危险因素（P<0.05）。 结论 宫高、巨大儿、多胎妊娠、肥胖、阻滞平面、注药速度、体位、Bezold-Jarisch反射是产妇蛛网膜下腔阻滞后发生低血压的危险因素，剖宫产手术时应充分考虑，确保产妇和胎儿安全。

[关键词] 剖宫产;蛛网膜下腔阻滞;低血压;因素;相关性

[中图分类号] R614.3          [文献标识码] B          [文章编号] 1673-9701（2021）07-0128-05

Related factors of hypotension in parturients with subarachnoid block after cesarean section

CHEN Pei1   LIU Lan2   ZHONG Taidi1   MEN Xin1   CHENG Mei1

1.Department of Anesthesiology， Hangzhou Women′s Hospital， Hangzhou   310008， China; 2.Department of Anesthesiology， the Second Affiliated Hospital of Zhejiang University School of Medicine， Hangzhou   310009， China

[Abstract] Objective To analyze the related factors of hypotension in lying-in women with subarachnoid block during cesarean section and provide reference for the prevention and treatment of hypotension. Methods The clinical data of 320 women with subarachnoid block who underwent cesarean section at the lower segment of the uterus from January to December 2018 in Hangzhou Women′s Hospital were analyzed retrospectively. The related factors of hypotension and treatment status after subarachnoid block were analyzed. Logistic regression analysis was used to screen the risk factors for hypotension（maternal factors， fetal factors， anesthetic factors， body position factors and Bezold-Jarisch reflex）. Results Among the 320 subjects， 143（44.69%） had hypotension. Among the patients with hypotension， 95（66.43%） patients were given single intravenous injection of 10 mg of ephedrine to treat hypotension and 48（33.57%） patients were given multiple intravenous injection of 10 mg of ephedrine to treat hypotension. It was showed by Logistic regression analysis that uterine height>36 cm， macrosomia， multiple pregnancies， body mass index（BMI）≥28 kg/m2， block plane≥T6， injection speed≤10 s， supine position， Bezold-Jarisch reflex were the risk factors for hypotension after subarachnoid block（P<0.05）. Among them， hypotension related to macrosomia， multiple pregnancies， BMI≥28 kg/m2， block plane≥T6， injection speed≤10 s， supine position， Bezol-Jarisch reflex required multiple injections of ephedrine to be treated（P<0.05）. Conclusion Uterine height， macrosomia， multiple pregnancies， obesity， block plane， injection speed， body position， Bezol-Jarisch reflex are risk factors for hypotension after subarachnoid block in puerpera， which should be fully considered during cesarean section to ensure the safety of puerpera and fetus.

[Key words] Cesarean section; Subarachnoid block; Hypotension; Factors; Correlation

剖宫产是终止妊娠的有效方式，我国剖宫产率在世界范围处于较高水平，特别是生育政策调整后，高龄产妇、瘢痕子宫、妊娠高血压综合征、难产等比例逐步增多，导致剖宫产率居高不下，甚至有增高趋势。蛛网膜下腔阻滞是剖宫产手术较为常用的麻醉方式，具有起效快、阻滞效果好等优点[1]，但可出现低血压，表现为血压低、心率快、胸闷、呼吸困难、恶心、呕吐等，严重可出现抽搐、神志不清甚至心跳骤停等，威胁产妇及胎儿安全。因此，积极防治蛛网膜下腔阻滞后低血压是产科麻醉的重点[2]，预先输液、体位调整、给予血管活性药物等虽能一定程度纠正低血压，但均存在一定不足[3]。若能……