產婦於脊髓麻醉時其上肢及下肢血壓之比較

The Blood Pressure of Upper and Lower Extremities in Parturients under Spinal Anesthesia for Cesarean Section

許汝寧(Yu-Ling Hui) ； 胡玉旺(Yuk-Wong Wu)

《Acta Anaesthesiologica Sinica》 33卷2期 (1995/06) Pp. 119-122

摘要

背景：臨床上，我們祇測量產婦手臂上的血壓，但它無法反映實際上產婦下半身血壓的變化。因此，我們利用產婦接受剖腹生產而施行半身麻醉的時候，同時記錄手臂及小腿的血壓，以觀察其間變化與差異。方法：選擇66位產婦接受剖腹生產而施行脊髓麻醉。所有的產婦在接受2 ml，0.5% spinal heavy bupivacaine做半身麻醉之前，先由靜脈灌注1500 ml之Ringer's lactate溶液。半身麻醉後，產婦平躺，再將手術檯向左傾斜15度。我們用Criticon Dinamap自動量血壓器二部，分別在上臂及小腿每分鐘測量產婦的血壓，直到手術開始。結果：發現下肢的血壓比上肢高。但是當有低血壓發生時，下肢比上肢早一點發現而且有時比上肢血壓更低，這些低血壓對嬰兒的Apgar Score並沒有什麼影響。結論：我們建議用半身麻醉來做剖腹生產的時候，最初10分鐘每一分鐘要量一次血壓，最好是量下肢的血壓，以便及早發現低血壓，加以處理以免發生憾事。

關鍵字

產婦 ； 半身麻醉 ； 血壓

並列摘要

Background: In clinical practice, we only measure the blood pressure of the arm during cesarean section. However, it can not accurately reflect the real image of pressure of the lower extremity in labor women. Therefore, we recorded simultaneously the arm and leg blood pressure in the term parturients undergoing cesarean section under spinal anesthesia. Methods: After hydration with 1500 ml lactated Ringer's solution, all patients received spinal anesthesia with 2ml (0.5%) spinal heavy bupivacaine. The right hip was elevated 15 degree to insure left uterine displacement. Prior to spinal block blood pressure of the arm and leg was measured and recorded simultaneously using a Criticon Dinamap vital sign monitor 1846sx and was continued in determination every minute thereafter until uterine incision. Results: We found that monitoring the lower extremity blood pressure might detect the onset of systemic hypotension more earlier and in some instances is disclosed hypotension that was not even detected by the arm cuff monitor. In addition, we found that the blood pressure in the leg was higher than that in the arm, but when hypotension occurred, it might fall even lower than that of the arm. Conclusions: We suggest that monitoring blood pressure in cesarean section under spinal anesthesia should be minute to minute for the first ten minutes and one had best monitor the lower extremity blood pressure in order to promptly detect hypotension.

並列關鍵字

Anesthesia: spinal ； Parturient ； Blood Pressure