肺超声技术在妊娠期高血压疾病产妇容量管理中的应用研究
Application of lung ultrasound in volume management for women with hypertensive disorders of pregnancy
张天书 1雷波 1赫金鑫 1闫合燕 1贺淑君 1郭敏 1王云娟 1王雷1
作者信息
- 1. 北京市海淀区妇幼保健院麻醉手术科,北京 100091
- 折叠
摘要
目的 探讨肺超声技术在妊娠期高血压疾病产妇容量管理中的应用效果.方法 选取2022年3月至2023年12月在北京市海淀区妇幼保健院住院行剖宫产术的妊娠期高血压疾病的产妇291例,按随机数字表法随机分为试验组(肺超声组)144例和对照组147例,肺超声组,在开腹前(T0)、胎儿娩出后5 min(T1)、手术结束(T2)实施肺超声扫查如显示肺损伤程度评分为2分时,给予利尿处理;对照组,当中心静脉压(CVP)＞12 cm H2O,或少尿时给与利尿处理.观察并记录2组产妇的年龄、身高、体质量、孕周、疾病类型;术中记录2组产妇 T0、T1、T2 时,平均动脉压(MAP)、心率;记录手术时长、术中液体入量、输血量、术中出血量、尿量、血管活性药物的剂量、利尿剂的剂量;肺超声组记录术毕(T2)两肺的肺损伤程度评分、CVP值、氧合指数(oxygenation Index,0I).记录2组产妇术后24 h肺部并发症的发生情况、住院时间.结果 2组产妇组间年龄、身高、体质量、孕周、疾病类型等比较,差异均无统计学意义(P＞0.05);2组产妇T0、T1、T2的MAP、心率比较,差异均无统计学意义(P＞0.05);2组产妇MAP、HR组内比较,差异具有统计学意义(P＜0.001)2组产妇手术时长、术中液体入量、输血量、术中出血量、尿量比较,差异均无统计学意义(P＞0.05);2组产妇术中血管活性药物的使用剂量比较,差异无统计学意义(P＞0.05);2组产妇呋塞米的使用剂量比较,差异具有统计学意义(P＜0.05);2组产妇肺部并发症的发生情况的比较差异有统计学意义(P＜0.05);2组住院时间比较,差异均无统计学意义(P＞0.05);试验组肺损伤程度评分与氧合指数(OI)呈显著负相关(r=-0.249,P=0.005);肺损伤程度评分与CVP值之间呈显著正相关(r=0.425,P＜0.01).结论 肺部超声技术可以直观、动态地评估妊娠期高血压疾病产妇的容量情况,在容量管理方面有一定的优势,值得临床推广应用.
Abstract
Objective To investigate the effect of lung ultrasound in volume management for women with hypertensive disorders of pregnancy.Methods A total of 291 pregnant women with hypertensive disorders of pregnancy who underwent cesarean section in Haidian Maternal & Child Health Hospital from March 2022 to December 2023 were selected and randomly divided into experimental group(LUS group)(144 cases)and control group(147 cases).In LUS group,lung ultrasound scan was performed before laparotomy,5min after fetal delivery,and after surgery.If the lung injury degree score was 2,furosemide injection was given.In control group,when CVP＞12 cmH2O or oliguria,furosemide injection was given treatment.Age,height,weight,gestational age and disease type of pregnant women in the two groups were observed and recorded.The mean arterial pressure(MAP)and heart rate(HR)were recorded before laparotomy(T0),5min after delivery(Tl)and at the end of operation(T2).Record the operation time,fluid transfusion volume,blood transfusion volume,blood loss volume,urinary volume,dose of vasoactive drugs,dose of diuretics.The lung injury degree score,CVP value and oxygenation index(OI)were recorded in the LUS group after surgery(T2).The incidence of pulmonary complications and length of hospital stay 24h after delivery were recorded in the two groups.Results There were no significant differences in age,height,weight,gestational age and disease type between the two groups(P＞0.05).There were no significant differences in MAP and heart rate before laparotomy(T0),5min after delivery(T1),and after operation(T2)between the two groups(P＞0.05).But Intra-group comparison of MAP and heart rate between the two groups showed statistically significant differenes(P＜0.001)fThere were no significant differences in operation duration,fluid transfusion,blood transfusion,blood loss and urine volume between the two groups(P＞0.05).The dosage of vasoactive drugs did not show a significant difference between the two groups(P＞0.05).However,there was a statistically significant variance in the dosage of furosemide between the two groups(P＜0.05).There was significant difference in pulmonary complications between the two groups(P＜0.05).There was no significant difference in Hospitalization days between the two groups(P＞0.05).Lung injury degree score was negatively correlated with oxygenation index(OI)(r=-0.249,P=0.003).There was a significant positive correlation between lung injury degree score and CVP value(r=0.425,P＜0.001).Conclusion Lung ultrasound can visually and dynamically evaluate the volume of pregnant women with hypertensive diseases during pregnancy,and has certain advantages in volume management,which is worthy of clinical application.
关键词
超声检查,产前/肺/高血压,妊娠性/孕产妇健康Key words
Ultrasonography,prenatal/Lung/Hypertension,pregnancy-induced/Materal health引用本文复制引用
基金项目
北京市海淀区卫生健康发展科研培育计划(HP2022-26-103003)
出版年
2024
NETL
NSTL
万方数据