| Objective:To observe the effect of lower limb wrapping with elastic bandage combined with low-dose phenylephrine on blood pressure and heart rate of parturients undergoing spinal cesarean section.Method:93 full-term singleton parturients who had undergone elective cesarean section and had no complications were selected,and were classified as ASA Grade I or II.Parturients were randomly divided into control group（C group）,elastic bandage group（E group）and elastic bandage+phenylephrine group（P group）.After entering the operating room,the three groups of parturients opened the venous channel,infused sodium lactate Ringer’s solution 10 ml/kg·h,punctured the left radial artery under local anesthesia,and monitored ECG,IBP,HR and Sp O2.After the parturients were calm,inclined to the left by 15 degree.The average values of BP and HR for three consecutive times（interval of 2 min）were taken as the basic values,and the basic value of 80%was calculated.In E group and P group,the lower limbs were raised by 40 degree～45 degree,and the elastic bandage was wrapped in a shingle shape from the ankle to the middle thigh.The tightness of the elastic bandage was one finger under the bandage,and the parturients had no discomfort,and the pulse of dorsalis pedis artery was palpable,and then the lower limbs were flattened.C Group were not bound with elastic bandage.Combined spinal-epidural anesthesia was performed in the right lateral decubitus position,and BP and HR were recorded once every minute immediately after intrathecal injection.If SBP decreased by more than20%or less than 90 mm Hg for two consecutive times,it was defined as blood pressure decrease,and 50μg phenylephrine was injected intravenously for the parturients in C and E groups immediately.If HR<60 bpm,0.25 mg atropine was given intravenously immediately.Immediately after intrathecal injection,P group started intravenous injection of phenylephrine 0.2μg/kg·min,and other treatments were the same as those of C group and E group.SBP and HR per minute were monitored and recorded within the first 20 minutes after intrathecal injection of drugs into spinal anesthesia.Record the intervention of phenylephrine and atropine between intrathecal injection and fetal delivery;Record the number of cases of adverse reactions among the three groups;Apgar scores at 1 min and 5 min Apgar blood gas values of umbilical cord artery and vein were recorded.Results:SBP decreased twice in C group at the 4th and 7th min after spinal anesthesia,decreased in E group at the 6th min,and remained stable in P group.At the4th and 7th minutes after spinal anesthesia,there was no significant difference in SBP between P and E groups（P>0.05）,but there was significant difference in SBP between two groups and C group（P<0.05）.At the 6th minute,there was significant difference in SBP between P and E groups（P<0.05）.Compared with other time points,there was no significant difference among the three groups（P>0.05）.In the first 10 minutes after spinal anesthesia,the HR of the three groups fluctuated greatly,among which the HR of C group increased twice in the 4th and 7th minutes after spinal anesthesia,and the HR of E group increased once in the 6th minute,while the HR of P group showed a slow downward trend.After 10 min,HR of the three groups were stable,and the HR of the three groups showed a short-term upward trend again when fetuses were taken.The average HR after spinal anesthesia was above 70 bpm.In C group,14 parturients needed intravenous phenylephrine after intrathecal injection,and the incidence of hypotension was 46.7%.However,there were only 9cases in E group,the incidence of hypotension was 29%,and the difference was statistically significant（P<0.05）.In P group,3 parturients were given phenylephrine intravenously,and the incidence of hypotension was 10%.Compared with the other two groups,the difference was statistically significant（P<0.05）.In terms of the intervention of phenylephrine and atropine,the intervention times of phenylephrine in C group were the most,followed by E Group and the least in P Group,and there was significant difference among the three groups（P<0.05）.Atropine was given to 5patients with bradycardia in C group,6 patients in E group and 5 patients in P group.There was no significant difference in the number and times of atropine intervention among the three groups（P>0.05）.The dosage of phenylephrine in E group was significantly less than that in C group（P<0.05）,but there was no significant difference between P group and C group（P>0.05）,but there was significant difference between group E（P<0.05）.In terms of chest tightness,nausea and vomiting:8 cases of parturients in C group had chest tightness,10 cases had nausea and 2 cases had vomiting;In E group,there were 2 cases of chest tightness,1 case of nausea,and no maternal vomiting.There was significant difference in the number of chest tightness and nausea between the two groups（P<0.05）.There were no cases of chest tightness,nausea and vomiting in P group,which was significantly different from that in C group（P<0.05）,but not significantly different from that in group E（P>0.05）.In the aspect of elevated blood pressure:There were 3,0 and 1 cases in C,E and P groups respectively,and there was no significant difference among the three groups（P>0.05）.The Apgar scores of newborns in the three groups were all above 7points at 1 minute and 10 points at 5 minutes,and there was no significant difference among the three groups（P>0.05）.The blood gas values of umbilical cord blood in the three groups were all within the normal range,and there was no significant difference between the three groups（P>0.05）.Conclusion:1.Lower limbs wrapping with elastic bandage can reduce the incidence of hypotension and the dosage of phenylephrine.2.Lower limbs wrapping with elastic bandage combined with low-dose of phenylephrine can significantly reduce the incidence of hypotension after spinal anesthesia in parturients,and it is worth popularizing and applying in elective cesarean section. |
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