剖宮產術中體位干預防治孕婦仰臥位低血壓綜合征的效果

彭畫梅，謝紅，胡小素

(1.北京大學第三醫院 手術室，北京 100191；2.北京大學 護理學院，北京 100191)

·技術與方法·

剖宮產術中體位干預防治孕婦仰臥位低血壓綜合征的效果

彭畫梅1，謝紅2，胡小素1

(1.北京大學第三醫院 手術室，北京 100191；2.北京大學 護理學院，北京 100191)

目的 探討剖宮產術中體位干預防治孕婦仰臥位低血壓綜合征(supine hypotensive syndrome，SHS)的效果，以期為有效降低仰臥位低血壓綜合征發生率提供重要臨床依據。方法 便利抽樣法選擇2013年7-8月，在某三級甲等醫院擇期或急診剖宮產手術孕婦共97例為研究對象，按分娩時間的先后將其分為對照組(49例)和觀察組(48例)。對照組孕婦麻醉后，仰臥時將手術床向左傾斜30°；觀察組孕婦在麻醉結束后仰臥時，將右臀部墊高4～5 cm，比較兩組孕婦入手術室時的血壓值，記錄麻醉5 min后血壓的下降情況，統計孕婦的不良反應和使用升壓藥的情況。結果 麻醉后，兩組孕婦血壓值的差異有統計學意義(P<0.05)。麻醉后，兩組孕婦舒張壓變化的差異有統計學意義[(-11.84±2.06)mmHgvs(-4.64±1.38)mmHg，t=-2.889,P=0.005]。對照組出現SHS癥狀13例(26.53%)，觀察組出現5例(10.42%)，差異有統計學意義(χ2=4.166，P=0.041)。出現SHS癥狀時即遵醫囑給予升壓藥麻黃堿1次，孕婦經處理后癥狀緩解。結論 剖宮產術中合理的體位干預，對預防剖宮產孕婦SHS的發生具有積極預防作用。

剖宮產；體位干預； 仰臥位低血壓綜合征

【 Abstract 】 Objective To discuss the effect of body position intervention on the prevention of supine hypotensive syndrome (SHS) in patients undergoing cesarean section,in order to provide clinical evidence to effectively reduce the incidence rate of SHS.Methods By convenience sampling,97 cases of patients with cesarean section were divided into control group (49 cases) and observation group (48 cases).Control group received the operation bed tilted to the left by 30° after anesthesia,while the observation group had 4-5 cm pads under right hip after the anesthesia.The blood pressure was compared between two group,the reduce of blood pressure after 5min anesthesia was recorded and the adverse reaction and the usage of pressor agents were analyzed.Results There was statistical significance of blood pressure value after anesthesia between two groups of patients (P<0.05),and also the difference of the change of diastolic pressure was statistically significant [(-11.84±2.06) mmHg vs (-4.64±1.38)mmHg，t=-2.889,P=0.005].There were 13 cases of SHS in control group (26.53%),and 5 cases in observation group (10.42%)(χ2=4.166，P=0.041).1 ephedrine was given when the SHS occurred according to the doctor,the adverse reaction was eased after treatment.Conclusion Reasonable posture intervention has effective preventive effect of cesarean section supine hypotension.

【 Key words 】 cesarean section;posture intervention;supine hypotensive syndrome

[Nurs J Chin PLA,2015，32(10)：74-76]

手術室護理是針對手術和麻醉過程中對患者造成的心理、生理功能紊亂而采取的各種護理措施[1]。仰臥位低血壓綜合征(supine hypotensive syndrome，SHS)發生于妊娠后期，由于增大的子宮壓迫下腔靜脈[2]，從而使回心血量和心排出量驟減，患者仰臥時出現血壓下降、惡心嘔吐、胸悶、心悸等一系列癥狀。剖宮產手術時，由于腰麻聯合硬膜外麻醉后,麻醉平面以下的血管擴張、血液淤滯，回心血量減少，可導致周圍血管擴張，血壓進一步下降[2]，加劇了孕婦的低血壓癥狀。……