| Object: This study compared effects of continuously pumping a small does ofphenylephrine to inputting a large amount of colloid on the circulatory indications,distribution and shifts of the body fluid via voluminal kinetics technique underEpidural anesthesia during cesarean delivery. The aim of this study was to offertheoretic basis for transfusion during cesarean section.Methods:The study consisted of30selected ASAⅠ-Ⅱ pregnances scheduled forelective cesarean section under Epidural anesthesia. Women with circulation、respiratory、hematological、endocrine system、hepatorenal disease and pregnancycomplications were excluded. Each patient was randomly assigned to one of the twostudy groups in average： control group-colloid control group, experimentalgroup-phenylephrine experiment group.All patients in control group were given500mlDextran40as preload before the start of the surgery, and then followed by10ml/kg/huntil the end of the surgery. A small amount of crystal fluid maintained the infusionpathway. Phenylephrine at6μg/kg/h pumped if there were downturn in BP, thenadjusted the rate of phenylephrine according to the circulation indications.We keptthe decrease of blood pressure less than30%of the baseline bloodpressure.Anesthesia method：Both groups were given5ml of2%Lido as a test doesthrough epidural catheter in routine epidural anesthesia.We observed the circulationindications, makeing sure that every patient didn’t suffer toxicosis of local anestheticsor subarachnoid anaesthesia. Then additional amount of10-15ml of2%Lido could beoffered. We kept the block level under T6.Observation indexs：We recorded the systolicblood pressure(SBP), diastolic blood pressure(DBP), mean arterialpressure(MAP),heart rate(HR) of10minutes of entering the operating room(T0),5minutes after test dose(T1),10minutes after test dose(T2),15minutes after test dose(T3), uterine incision(T4), fetus removed(T5),5minutes after fetus removed(T6),20minutes before the end of surgery(T7), end of surgery(T8).And collected peripheralvenous blood (in order to obtain Hb and Hct),urine volume and blood loss volume ofT4and T8.We analysised the status of volume expand effect and the net change inextravascular fluid volume with volume kinetics. In addition to all of these, we alsoperformed statistical analysis on all results of measurements and calculates(BV、PV、EVV、VEE).Result:All these time-points of blood pressure in both groups had no statisticalsignificance. The heart rate in control group was gradually increased. There wasstatistical significance at T6between groups. BV、PV、Hb、Hct had difference betweenpregnant women and normal women at the same ages.There were statisticalsignificance between groups in BV at T4and T8. Comparing T0with T4and T8, P＜0.05, had differences in control group. The change trend of PV was the same as BV.There were no difference in SV and UV at T4and T8between groups. At T4and T8,Hb and Hct in control group were much lower than these in experimental group(P＜0.05). VEE at T4and T8also had difference between the two groups, while there was adifferential in control group.There was statistical significance in EVV between groupsat T4.Conclusion: Colloid fluid had a high rate of fluid retention and a strong effect ofvolume expand.Crystal fluid had a weak volume expand effect,and part of the liquidtransfered to extravascular compartment. Volume expand could treat the hypotensionresulting from Epidural anesthesia in cesarean section. But this method increased theheart rate and blood dilution. The use of phenylephrine not only maintained the bloodpressure but also stabilized the heart rate.It avoided hemodilution from a mass of liquidinfusion. So intraoperative keeping on infusing small does of phenylephrine was asafe、effective and suitable for maternal physical method. |
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