Objective To study the pretreatment with hydroxyethyl starch on the maternal hemodynamics and oxygen supply-demand balance in fetus during cesarean section under combined spinal-epidural anesthesia ( CSEA ). Methods 60 patients undergoing elective cesarean section under CSEA( Lj_4 ),were randomly divided into hydroxyethyl starch group ( Group HES,re=30 )and sodium lactate ringer's solution group ( Group LR,re=30 ). The patients were infused IV with hydroxyethyl starch or sodium lactate ringer's solution 500 mL, respectively before anesthesia. The SBP, DBP, HR and SpO2 were monitored and recorded at the following time-points: entering the operating room ( To ), the end of pre-filling liquid infusion ( Tj ), 5 min after subarachnoid anesthesia ( T2 ), fetus being born( T3 ), and the end of operation ( T4 ). The difference of blood pH value ( pHv-a ), partial pressure of oxygen ( Pv-aO2 ), saturation of oxygen ( Sv-aO2 ), content of oxygen ( Cv-aO2 )and fetal oxygen absorbing rate ( ERO2 )in arterial and venous blood were calculated according to blood gas analysis, which were achieved from collecting fetus umbilical arterial and venous blood when the fetus was born, and the oxygen supply-demand balance in fetus were assessed comprehensively. The Apgar scores of neonates were valued. Results Compared with Group HES, the values of SBP or DBP from T2 to T4 significantly decreased and HR were significantly faster in Group LR( P<0.05 ). The incidence of hypotension and amount of ephedrine used in Group LR were significantly higher than those in Group HES,respectively ( P<0. 05 ). Compared with those in Group LR, the blood pH in fetal umbilical arterial and venous blood, PvO2 , SvO2 and CvO2 in umbilical vein, Pv-aO2 , Sv-aO2 ,Cv-aO2 and ERO2 in both fetal umbilical arterial and venous blood in Group HES were all obviously higher [ pH:( 7. 29 ± 0.03 )vs ( 7.26±0.06 ),PvO2:( 4. 23±0.61 )vs ( 3. 26±0.68 ) kPa,SvO2:( 67. 2±10.5 )% vs ( 56. 3±12.0 )% ,CvO2:( 170.4 ±14.0 )vs ( 122.6±13. 3 ) mL ? L"1 ,Pv-aO2:( 1. 62±0. 50 )vs ( 0. 92±0. 85 ) kPa,Sv-aO2:( 33.1±7.2 )% vs ( 22.5±9.0 ),Cv-aO2 :( 86. 3±11. 6 )vs ( 53. 4±16. 5 )% ,ERO2 :( 51. 5±6. 3 )vs ( 44. 2±8. 9 )% ,P<0. 05 ]. While the fetus was delivered, there was no consipicuous difference in Apgar scores of fetus between two groups. Conclusion Pretreatment with hydroxyethyl starch could maintain the hemodynamic stability of mothers during cesarean section under CSEA, increase the oxygen supply to fetus and improve uptake and utilization of oxygen for fetus.%目的 观察羟乙基淀粉预处理对腰-硬联合麻醉(CSEA)下剖宫产术产妇血流动力学及胎儿氧供需平衡的影响.方法 择期行剖宫产术产妇60例,于L3～4行腰-硬联合麻醉,随机均分为羟乙基淀粉组(HES组)和乳酸钠林格溶液组(LR组).麻醉前两组患者分别输注预充液羟乙基淀粉或乳酸钠林格液500 mL.监测并记录入手术室时(T0)、预充液输注完即刻(T1)、蛛网膜下腔注入局药后5 min(T2)、胎儿娩出时(T3)和术毕(T4)时收缩压(SBP)、舒张压(DBP)、心率(HR)和血氧饱和度(SpO2)变化情况;胎儿娩出时采脐动、静脉血行血气分析,计算脐静、动脉血酸碱度差(pHv-a)、氧分压差(Pv-aO2)、氧饱和度差(Sv-aO2)、氧含量差(Cv-aO2)及胎儿氧摄取率(ERO2),以综合评估胎儿的氧供需平衡状况;、同时行出生时新生儿Apgar评分.结果 与T0时及HES组对应值比较,T2～T4时LR组患者SBP、DBP明显下降,HR显著增快(P＜0.05);LR组低血压发生率和麻黄碱应用量均明显高于HES组(P＜0.05);HES组的胎儿脐动、静脉血pH(7.29±0.03),脐静脉PvO2(4.23±0.61) kPa、SvO2(67.2±10.5)%、CvO2(170.4±14.0) mL·L-1,脐静、动脉Pv-aO2(1.62±0.50) kPa、Sv-aO2(33.1±7.2)%、Cv-aO2(86.3±11.6) mL·L-1和ERO2(51.5±6.3)%均高于LR组[pH:(7.26±0.06),PvO2:(3.26±0.68) kPa,SvO2:(56.3±12.0)%,CvO2:(122.6±13.3) mL·L-1,Pv-aO2:(0.92±0.85) kPa,Sv-aO2:(22.5±9.0)%,Cv-aO2:(53.4±16.5) mL·L-1,ERO2:(44.2±8.9)%](均P＜0.05);胎儿娩出后,两组新生儿出生时1和5 min 的Apgar评分差异无统计学意义.结论 羟乙基淀粉预处理能维持CSEA下剖宫产术时母体的血流动力学稳定,增加母体对胎儿的氧供,并提高胎儿对氧的摄取和利用.
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