浙江医学2026，Vol.48Issue(5)：517-522,527,7.DOI:10.12056/j.issn.1006-2785.2026.48.5.2025-1579
基于局部脑氧饱和度的血压管理策略对剖宫产蛛网膜下腔麻醉后低血压的预防效果
Effect of blood pressure management strategy based on regional cerebral oxygen saturation on the prevention of spinal anaes-thesia-induced hypotension during cesarean section
摘要
Abstract
Objective To explore the feasibility and effect of blood pressure management strategy based on regional cerebral oxygen saturation(rScO2)in preventing spinal anaesthesia-induced hypotension(SAIH)in cesarean section.Methods A total of 130 elective cesarean section patients admitted to the Chengdu Second People's Hospital from August 2022 to August 2023 were prospectively selected and randomly divided into the rScO2 monitoring group and the conventional monitoring group according to the random number table method,each with 65 cases.In the rScO2 monitoring group,blood pressure was elevated when the rScO2 value decreased to 4.5％of the baseline value,while in the conventional monitoring group,blood pressure was elevated when the systolic blood pressure decreased to 80％of the baseline value.Systolic blood pressure,heart rate,and rScO2 values were recorded at before anesthesia(T0),1 minute after anesthesia(T1),3 minutes after anesthesia(T2),5 minutes after anesthesia(T3),10 minutes after anesthesia(T4),at the time of blood pressure elevation(T5),at the time of fetal delivery(T6),and at the end of the operation(T7).The time-weighted average hypotension value from spinal anesthesia to the time before fetal delivery,the number of hypotension cases,the first blood pressure elevation time,the number of blood pressure elevations before fetal delivery,and the number of cases of reactive hypertension were recorded.The adverse reactions(dizziness,nausea,vomiting,and chills)of the parturients before fetal delivery were recorded.Umbilical artery blood gas analysis(pH,base excess,lactate,partial pressure of oxygen,partial pressure of carbon dioxide,and blood glucose),neonatal weight,and the number of cases with Apgar score ≤7 at 1 minute after birth,as well as Apgar scores at 1 minute and 5 minutes after birth were recorded.Results There were significant differences in the main effects of group,time,and group × time interaction in systolic blood pressure,heart rate,and rScO2 values between the two groups(all P＜0.05).The systolic blood pressure of both groups decreased significantly at T2 to T6 compared with T0(all P＜0.05).The systolic blood pressure of the rScO2 monitoring group was significantly higher than that of the conventional monitoring group at T2 to T5(all P＜0.05).The heart rate of the rScO2 monitoring group decreased significantly at T1 to T5 compared with T0(all P＜0.05),while the heart rate of the conventional monitoring group decreased significantly at T1 to T4 compared with T0(all P＜0.05)and increased significantly at T5 compared with T0(P＜0.05).The heart rate of the rScO2 monitoring group was significantly lower than that of the conventional monitoring group at T2 to T5(all P＜0.05).The rScO2 values of both groups decreased significantly at T1 to T5 compared with T0(all P＜0.05).The rScO2 of the rScO2 monitoring group was significantly higher than that of the conventional monitoring group at T2 to T5(all P＜0.05).The time-weighted average hypotension value,the number of hypotension cases after spinal anesthesia,and the first blood pressure elevation time of the rScO2 monitoring group were significantly lower than those of the conventional monitoring group(all P＜0.05),while the number of blood pressure elevations before fetal delivery was significantly higher(P＜0.05).There was no significant difference in the number of cases of reactive hypertension between the two groups(P＞0.05).The number of cases of dizziness,nausea,and vomiting in the rScO2 monitoring group was significantly lower than that in the conventional monitoring group(all P＜0.05).There were no significant differences in umbilical artery blood gas analysis,birth weight,the number of cases with Apgar score ≤7 at 1 minute after birth,and Apgar score at 1 minute and 5 minutes between the two groups(all P＞0.05).Conclusion The blood pressure management strategy based on rScO2 monitoring can reduce the exposure time and degree,incidence,and related adverse reactions of spinal anaesthesia-induced hypotension for cesarean section,and the hemodynamic indicators are more stable.It has no adverse effects on neonatal outcomes and provides a promising new strategy for preventing spinal anaesthesia-induced hypotension for cesarean section.关键词
局部脑氧饱和度/血压管理/剖宫产/蛛网膜下腔麻醉后低血压Key words
Regional cerebral oxygen saturation/Blood pressure management/Cesarean section/Spinal anaesthesia-induced hypotension引用本文复制引用
刘佳,谢科宇,何敬熹,朱波..基于局部脑氧饱和度的血压管理策略对剖宫产蛛网膜下腔麻醉后低血压的预防效果[J].浙江医学,2026,48(5):517-522,527,7.基金项目
四川省卫生健康委员会医学科技项目(21PJ140) （21PJ140）
成都市卫生健康委员会医学科技项目(2023045) （2023045）
