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通讯作者:

彭艳,E-mail:jasmine1982@163.com

中图分类号:R614.3

文献标识码:A

文章编号:1007-4368(2022)07-1007-06

DOI:10.7655/NYDXBNS20220714

参考文献 1
SIVEVSKI A,IVANOV E,KARADJOVA D,et al.Spinal⁃ induced hypotension in preeclamptic and healthy parturi⁃ ents undergoing cesarean section [J].Open Access Maced J Med Sci,2019,7(6):996-1000
参考文献 2
NIKOOSERESHT M,SEIF RABIEI M,HAJIAN P,et al.Comparing the hemodynamic effects of spinal anesthesia in preeclamptic and healthy parturients during cesarean section[J].Anesth Pain Med,2016,6(3):e11519
参考文献 3
刘世乐,刘晓磊,陈志强,等.不同麻醉方式在剖宫产术中的应用比较[J].广东医学,2018,39(9):1283-1286
参考文献 4
VISALYAPUTRA S,RODANANT O,SOMBOONVI⁃ BOON W,et al.Spinal versus epidural anesthesia for ce⁃ sarean delivery in severe preeclampsia:a prospective ran⁃ domized,multicenter study[J].Anesth Analg,2005,101(3):862-868
参考文献 5
ZWANE S,BISHOP D,RODSETH R.Hypotension dur⁃ ing spinal anaesthesia for caesarean section in a resourcelimited setting:towards a consensus definition[J].South Afr J Anaesth Analg,2019,25(1):1-5
参考文献 6
CHOOI C,COX J,LUMB R,et al.Techniques for prevent⁃ ing hypotension during spinal anaesthesia for caesarean section[J].Cochrane Database Syst Rev,2020,7:CD002251
参考文献 7
QIAN X,WANG Q,OU X,et al.Effects of ropivacaine in patient ⁃ controlled epidural analgesia on uterine electro⁃ myographic activities during labor[J].Biomed Res Int,2018,2018:7162865
参考文献 8
CHUMPATHONG S,SIRITHANETBHOL S,SALAKIJ B,et al.Maternal and neonatal outcomes in women with se⁃ vere pre ⁃ eclampsia undergoing cesarean section:a 10 ⁃ year retrospective study from a single tertiary care center:anesthetic point of view[J].J Matern Fetal Neonatal Med,2016,29(24):4096-4100
参考文献 9
AYA A,VIALLES N,TANOUBI I,et al.Spinal anesthesia⁃ induced hypotension:a risk comparison between patients with severe preeclampsia and healthy women undergoing preterm cesarean delivery[J].Anesth Analg,2005,101(3):869-875
参考文献 10
KEE W,KHAW K,TAM Y,et al.Comparison of closed⁃ loop feedback computer⁃controlled and manual⁃controlled phenylephrine infusions during spinal anaesthesia for cae⁃ sarean section[J].Int J Obstet Anesth,2011,20:S17
参考文献 11
LAVIE A,RAM M,LEV S,et al.Maternal cardiovascular hemodynamics in normotensive versus preeclamptic preg⁃ nancies:a prospective longitudinal study using a noninva⁃ sive cardiac system(NICaSTM)[J].BMC Pregnancy Child⁃ birth,2018,18(1):229
参考文献 12
王清津,刘可,蔡晓玲,等.子痫前期患者血浆儿茶酚胺与其新生儿脐血儿茶酚胺的研究[J].南方医科大学学报,2008,28(7):1309-1310
参考文献 13
茆庆洪,宋娟.剖宫产腰麻痛觉阻滞平面上界的相关因素分析[J].南京医科大学学报(自然科学版),2009,29(9):1293-1295
参考文献 14
ROOFTHOOFT E,VAN D V M.Low ⁃dose spinal anaes⁃ thesia for caesarean section to prevent spinal⁃induced hy⁃ potension[J].Curr Opin Anaesthesiol,2008,21(3):259-262
参考文献 15
MALHOTRA R,JOHNSTONE C,HALPERN S,et al.Du⁃ ration of motor block with intrathecal ropivacaine versus bupivacaine for caesarean section:a meta⁃analysis[J].Int J Obstet Anesth,2016,27:9-16
参考文献 16
ANIM⁃SOMUAH M,SMYTH R M,CYNA A M,et al.Epi⁃ dural versus non ⁃ epidural or no analgesia for pain man⁃ agement in labour[J].Cochrane Database Syst Rev,2018,5(5):CD000331
目录contents

    摘要

    目的:观察子痫前期产妇行腰麻剖宫产时低血压的发生率。方法:选择择期腰麻下行子宫下段剖宫产手术的产妇共100例,分为子痫前期组(SE组)和正常产妇组(H组),每组50例。腰麻穿刺成功后,蛛网膜下腔注射0.75%罗哌卡因1.5 mL 加入 10 μg 芬太尼。记录产妇麻醉前(T0)、麻醉后 3 min(T1)、6 min(T2)、9 min(T3)、12 min(T4)、15 min(T5)、胎儿娩出时 (T6)、胎儿娩出后5 min(T7)、手术结束时(T8)的收缩压、舒张压、平均动脉压和心率;记录麻黄碱和去氧肾上腺素的使用量。结果:SE组产妇麻醉后低血压的发生率为20%,明显低于H组(P < 0.05),且在T1~T4时间点平均动脉压下降的百分比也低于 H组(P < 0.05);SE组麻黄碱的使用量低于H组[(3.5±1.8)mg vs.(8.5±2.6)mg,P < 0.05]。结论:子痫前期产妇在使用低剂量局麻药物复合阿片类药物进行腰麻剖宫产时低血压的发生率低于健康足月产剖宫产的产妇;加强麻醉管理,腰麻可安全用于子痫前期产妇。

    Abstract

    Objective:To observe the incidence of hypotension in women with preeclampsia undergoing lumbar anesthesia cesarean. Methods:A total of 100 pregnant women undergoing elective cesarean section under spinal anesthesia were divided into SE group (preeclampsia group)and H group(normal parturient group),50 cases in each group. After successful lumbar anesthesia puncture, 1.5 mL 0.75% ropivacaine and fentanyl mixture was injected into subarachnoid sapce;SBP,DBP,MAP and HR were recorded before anesthesia(T0),3 min(T1),6 min(T2),9 min(T3),12 min(T4),and 15 min(T5)after anesthesia,at delivery(T6),5 min after delivery(T7)and at the end of operation(T8). The total amount of ephedrine and phenylephrine used during operation were recorded. Results:The incidence of hypotension was 20% in SE group,lower than that in H group(50%)(P < 0.05). The percentage of MAP decrease at T1~T4 time point was significantly lower than that in H group(P < 0.05). The usage of ephedrine in SE group was lower than that in H group(3.5±1.8)mg vs.(8.5±2.6)mg(P < 0.05). Conclusion:The incidence of hypotension in women with preeclampsia undergoing lumbar anesthesia cesarean section with low dose local anesthesia combined with opioids is lower than that of healthy women with full ⁃ term cesarean section. Enhance anesthesia management,lumbar anesthesia can be used safely for preeclampsia parturient.

    关键词

    子痫前期剖宫产腰麻低血压局麻药阿片类

  • 子痫前期患者行剖宫产手术,关于麻醉方式的选择一直存有争议,常见的观点认为,子痫前期患者在蛛网膜下腔阻滞麻醉时,会引起严重的低血压,并降低子宫胎盘灌注[1];然而,也有研究表明,子痫前期患者因交感神经兴奋、血管张力高,腰麻后低血压的发生率较正常产妇低,尤其是腰麻使用低剂量的局麻药复合芬太尼或者舒芬太尼时[2]。本研究旨在比较子痫前期和正常产妇在芬太尼复合罗哌卡因腰麻下进行剖宫产时低血压发生率的差异,供临床参考。

  • 1 对象和方法

  • 1.1 对象

  • 选择2021年1—12月于苏州大学附属第一医院行子宫下段剖宫产的产妇共100例,孕33~41周,分为子痫前期组(SE组)和正常产妇组(H组),每组50例。本研究获苏州大学附属第一医院医学伦理委员会批准(伦理批准号2021109);所有产妇签署知情同意书。

  • SE组患者年龄20~35岁,体重50~85kg,美国麻醉医师协会(ASA)分级Ⅱ或Ⅲ级,均诊断为子痫前期,妊娠20周后出现收缩压≥140mmHg和/或舒张压≥90mmHg伴蛋白尿≥0.3g/24h或随机尿蛋白阳性。在腰麻穿刺前4h停止静脉降压药物,硫酸镁的治疗可以持续到术前。H组患者年龄20~35岁,体重50~85kg,ASAⅠ~Ⅱ级,无高血压病史。

  • 排除标准:①有椎管内麻醉禁忌;②合并严重心脑血管、内分泌、呼吸系统疾病;③脊柱侧弯;④严重的妊娠期糖尿病、严重的胎儿宫内窘迫或者胎盘早剥、妊娠<33周、前置胎盘、脐带脱垂、 Hellp综合征等。

  • 实验终止标准:出现子痫或者胎儿宫内窘迫等需要行紧急剖宫产者,改变麻醉方式者,或者子痫期出现病情改变,术前4h需要使用静脉降压药物来紧急降压者。

  • 1.2 方法

  • 1.2.1 麻醉方法

  • 产妇进入手术室后均给予鼻导管吸氧(2L/min),行心电图、无创血压、脉搏血氧饱和度(SpO2)监测, 18G导管开放上肢静脉,静脉给予钠钾镁钙葡萄糖注射液10mL/min匀速滴注。左侧卧位,皮肤消毒后铺巾,选择L2~L3或L3~L4间隙,采用上侧旁入法穿刺,16G硬膜外穿刺针进入硬膜外腔,后用5G蛛网膜穿刺针穿刺进蛛网膜下腔,见有脑脊液回流后,注入0.75%罗哌卡因(阿斯利康公司,瑞典) 1.5mL混合10 μg芬太尼(宜昌人福药业)后加脑脊液共2.5mL,30s内推注完毕,拔出穿刺针。改为仰卧位,右侧臀部垫高30°,调整阻滞平面,上端控制痛觉消失平面在T6~T8。平均动脉压(mean arterial pressure,MAP)低于基础值的20%时定义为麻醉后低血压,静脉注射麻黄碱5mg,30s后复测,如没有纠正,再次静脉注射5mg麻黄碱,如果仍没有纠正,则静脉注射25 μg去氧肾上腺素。满意度可按照麻醉效果分为1~4级[3]:1级,镇痛非常满意、手术医生认为产妇腹肌松,无牵拉反应;2级,镇痛良好,手术医生认为产妇腹肌稍紧;3级,镇痛效果一般或疼痛轻微持续,或手术医生认为产妇腹肌较紧,存在轻的牵拉反应;4级,镇痛差,产妇感觉疼痛剧烈,硬膜外需再加药。新生儿内环境情况:胎儿娩出后在呼吸前断脐并抽取脐动脉血,采用血气分析仪检测胎儿血气指标,pH值、PCO2、PO2并记录血钾、血钠、血钙等情况。

  • 1.2.2 观察指标

  • 记录麻醉前(T0)、麻醉后3min(T1)、6min (T2)、9min(T3)、12min(T4)、15min(T5)、胎儿娩出时(T6)、胎儿娩出后5min(T7)、手术结束时 (T8)的收缩压(systolic blood pressure,SBP)、舒张压 (diastolic blood pressure,DBP)、MAP和心率(heart rate,HR)的数值变化。记录麻黄碱和去氧肾上腺素的使用总量,出血量及尿量。记录新生儿出生后1、5、10min的Apgar评分及呼吸前血气分析指标。记录产妇麻醉后手术切口疼痛感消失时间、麻醉中的满意度评分及相关不良反应,包括恶心、呕吐、术后头痛。

  • 1.3 统计学方法

  • 采用SPSS 25.0进行数据整理和统计分析,研究对象年龄、孕周、麻黄碱和去氧肾上腺素的使用量、出血量、尿量用均数±标准差(x-±s)表示,两组间比较采用独立样本 t 检验;低血压持续时间采用中位数(四分位数)[MP25P75)]进行统计描述,采用非参数检验进行组间比较;各时间点的SBP、DBP、 MAP、HR、Apgar分值统计使用重复测量的方差分析;低血压发生率、血压下降百分比、心率变化值百分比、患者麻醉满意度和不良反应率等分类变量采用构成比(%)表示,采用卡方检验或Fisher精确检验,P< 0.05为差异有统计学意义。

  • 2 结果

  • 2.1 两组一般资料及不良反应比较

  • 本研究100例产妇均完成实验观察,SE组和H组各50例,两组产妇手术时间、出血量及胎儿娩出后1、5、10min Apgar评分比较差异均无统计学意义(P> 0.05)。腰麻注药后5min,恶心、呕吐SE组6例,H组8例,差异无统计学意义(P> 0.05)。术后头痛SE组2例,H组3例,差异无统计学意义(P> 0.05,表1)。

  • 2.2 两组升压药使用情况及血压变化比较

  • 两组在年龄、孕周、麻黄碱使用量、去氧肾上腺素使用量、低血压的发生率方面差异均有统计学意义(P< 0.05)。SE组低血压的发生率为20%,显著低于H组(50%),SE组麻黄碱的使用量低于H组 [(3.5±1.8)mg vs.(8.5±2.6)mg,P< 0.05],SE组基本没有使用去氧肾上腺素(表2)。

  • 两组患者在蛛网膜下腔阻滞后MAP有所下降 (图1),SE组在T3时间点与T0比较差异有统计学意义(P< 0.05),而H组在T2、T3时间点与T0比较差异有统计学意义(P< 0.05)。两组间MAP下降的百分比在T4、T5、T6、T7、T8时间点差异无统计学意义,但SE组在T1、T2、T3、T4时间点MAP下降的百分比明显低于H组(最低下降了35%)(图2);两组HR在各时间点均有不同程度的升高,其变化值在各时间点组间比较差异无统计学意义(P> 0.05),但在T3时间点两组变化值(与基础值比较)在所有观察时间点中差异最大,分别为25.0%和20.0%;两组HR在T3时间点变化值与T0比较差异均有统计学意义(P< 0.05,图3)。

  • 表1 两组患者一般临床特征

  • Table1 Basic clinical characteristics of the patients in the two groups

  • 表2 两组患者血压变化情况

  • Table2 Changes of blood pressure in the two groups

  • *:低血压发生率指各组发生低血压的产妇数占总例数的百分比,在8个时间点内任何1个或多个点出现都只算1例。

  • 图1 两组在各时间点MAP的下降趋势图

  • Fig.1 Descending trend of MAP at each point of the two groups

  • 图2 两组在各时间点MAP降低的百分比

  • Fig.2 Percentage of MAP reduction at each time point in the two groups

  • 图3 两组HR升高百分比组内比较

  • Fig.3 Intra⁃group comparison of the percentage of HR increase between the two groups

  • 2.3 两组患者麻醉满意度比较

  • 子痫前期组的手术切口疼痛感觉消失时间明显较健康产妇组短,SE组为(3.4±1.1)min,H组为 (6.2±1.5)min,差异有统计学意义(P< 0.05)。产妇麻醉满意度两组比较差异有统计学意义(P< 0.05,表3)。

  • 表3 两组患者麻醉满意度比较

  • Table3 Comparison of satisfaction between the two groups

  • 2.4 新生儿内环境的比较

  • 两组新生儿pH、PO2、PCO2、血钾、血钠和血钙水平差异均无统计学意义(P> 0.05,表4)。

  • 3 讨论

  • 以往的理论认为,妊娠合并高血压特别是重度子痫的产妇,选择椎管内麻醉会导致严重的低血压或者子宫胎盘血流灌注减少,即使选择,也应谨慎,并推荐采用硬膜外麻醉和小剂量分次给药的方法,但是这一观点越来越受到质疑[4-5]。临床实践表明,腰麻用于子痫前期患者行剖宫产越来越多,而且通过采用控制局麻药的剂量,联合使用阿片类药物,严格控制麻醉平面的方法,这类产妇的麻醉管理和血流动力学的波动反而有更加平稳的报道[6-7]。况且,腰麻用于剖宫产手术具有起效快、效果明确、穿刺简单、组织损伤较小、硬膜外血肿发生率低、紧急剖宫产手术时赢得时间等优点。

  • 表4 两组新生儿内环境比较

  • Table4 Comparison of neonatus internal environment between the two groups

  • 3.1 对产妇血压的影响

  • 在一项为期10年对多名重度子痫前期产妇行腰麻下剖宫产手术的前瞻性研究中,Chumpathong等[8] 的结论是,腰麻和硬膜外麻醉所致的低血压发生率无明显差异。而Aya等[9] 的前瞻性研究中发现,子痫前期患者在使用腰麻进行剖宫产手术时低血压的发生率较健康产妇低。Nikooseresht等[2] 报道子痫前期患者剖宫产时低血压的发生率为55%,而正常产妇是89%;主要原因可能与胎儿的大小、对主动脉及下腔静脉的压迫程度、交感神经兴奋、较高的血管张力等有关[10]

  • 3.2 对血管活性药物的影响

  • 合并妊高症的产妇通常终止妊娠的时机要比正常产妇早,所以胎儿及子宫的体积相对小,腰麻后对主动脉及下腔静脉的压迫亦相对减轻[6],但是, Aya等[9] 的研究表明,蛛网膜下腔阻滞麻醉后,子痫前期患者低血压的发生更可能是由其他因素导致。子痫前期产妇通过小血管内皮依赖性调节血管收缩舒张系统,使血管紧张性维持在一个相对较高的水平上。蛛网膜下腔阻滞麻醉后,正常产妇出现血管明显舒张,血容量相对不足而发生严重的低血压[11],而妊高症产妇通常体内含有较高水平的血管加压素[12],表现为血管的收缩功能较为敏感,舒张功能相对较弱,这可能是本研究中子痫前期产妇低血压发生率低的主要原因。

  • 腰麻诱发性低血压与局麻药的剂量有关[13]。在一项重度子痫前期患者剖腹产的初步研究中,发现7.5mg布比卡因组产妇麻醉后麻黄碱的需求量较10mg布比卡因组产妇更低。而在Roofthooft等[14] 研究中,已经证明了6.5mg布比卡因与舒芬太尼合用可以满足1h以内的剖宫产麻醉。本研究使用的罗哌卡因剂量为11.25mg,较一般腰麻使用剂量 (15mg)小[15],另外,芬太尼脂溶性强,小剂量即可增强腰麻时麻醉效果[16],而对胎儿没有不良影响。

  • 3.3 产妇麻醉满意度及术后镇痛的效果

  • 本研究中,SE组的手术切口疼痛消失时间明显短于H组,且麻醉满意度1级的比例达到了90%,新生儿内环境无明显差异,10 μg的芬太尼用于腰麻的效果有优势且安全。此外并没有增加不良反应如恶心、呕吐、低血压、胎儿呼吸抑制的发生率。

  • 综上所述,子痫前期产妇在使用较小剂量的局麻药复合阿片类药物行腰麻剖宫产时低血压的发生率低于正常足月剖宫产的产妇;加强麻醉管理,腰麻可安全用于子痫前期产妇。

  • 参考文献

    • [1] SIVEVSKI A,IVANOV E,KARADJOVA D,et al.Spinal⁃ induced hypotension in preeclamptic and healthy parturi⁃ ents undergoing cesarean section [J].Open Access Maced J Med Sci,2019,7(6):996-1000

    • [2] NIKOOSERESHT M,SEIF RABIEI M,HAJIAN P,et al.Comparing the hemodynamic effects of spinal anesthesia in preeclamptic and healthy parturients during cesarean section[J].Anesth Pain Med,2016,6(3):e11519

    • [3] 刘世乐,刘晓磊,陈志强,等.不同麻醉方式在剖宫产术中的应用比较[J].广东医学,2018,39(9):1283-1286

    • [4] VISALYAPUTRA S,RODANANT O,SOMBOONVI⁃ BOON W,et al.Spinal versus epidural anesthesia for ce⁃ sarean delivery in severe preeclampsia:a prospective ran⁃ domized,multicenter study[J].Anesth Analg,2005,101(3):862-868

    • [5] ZWANE S,BISHOP D,RODSETH R.Hypotension dur⁃ ing spinal anaesthesia for caesarean section in a resourcelimited setting:towards a consensus definition[J].South Afr J Anaesth Analg,2019,25(1):1-5

    • [6] CHOOI C,COX J,LUMB R,et al.Techniques for prevent⁃ ing hypotension during spinal anaesthesia for caesarean section[J].Cochrane Database Syst Rev,2020,7:CD002251

    • [7] QIAN X,WANG Q,OU X,et al.Effects of ropivacaine in patient ⁃ controlled epidural analgesia on uterine electro⁃ myographic activities during labor[J].Biomed Res Int,2018,2018:7162865

    • [8] CHUMPATHONG S,SIRITHANETBHOL S,SALAKIJ B,et al.Maternal and neonatal outcomes in women with se⁃ vere pre ⁃ eclampsia undergoing cesarean section:a 10 ⁃ year retrospective study from a single tertiary care center:anesthetic point of view[J].J Matern Fetal Neonatal Med,2016,29(24):4096-4100

    • [9] AYA A,VIALLES N,TANOUBI I,et al.Spinal anesthesia⁃ induced hypotension:a risk comparison between patients with severe preeclampsia and healthy women undergoing preterm cesarean delivery[J].Anesth Analg,2005,101(3):869-875

    • [10] KEE W,KHAW K,TAM Y,et al.Comparison of closed⁃ loop feedback computer⁃controlled and manual⁃controlled phenylephrine infusions during spinal anaesthesia for cae⁃ sarean section[J].Int J Obstet Anesth,2011,20:S17

    • [11] LAVIE A,RAM M,LEV S,et al.Maternal cardiovascular hemodynamics in normotensive versus preeclamptic preg⁃ nancies:a prospective longitudinal study using a noninva⁃ sive cardiac system(NICaSTM)[J].BMC Pregnancy Child⁃ birth,2018,18(1):229

    • [12] 王清津,刘可,蔡晓玲,等.子痫前期患者血浆儿茶酚胺与其新生儿脐血儿茶酚胺的研究[J].南方医科大学学报,2008,28(7):1309-1310

    • [13] 茆庆洪,宋娟.剖宫产腰麻痛觉阻滞平面上界的相关因素分析[J].南京医科大学学报(自然科学版),2009,29(9):1293-1295

    • [14] ROOFTHOOFT E,VAN D V M.Low ⁃dose spinal anaes⁃ thesia for caesarean section to prevent spinal⁃induced hy⁃ potension[J].Curr Opin Anaesthesiol,2008,21(3):259-262

    • [15] MALHOTRA R,JOHNSTONE C,HALPERN S,et al.Du⁃ ration of motor block with intrathecal ropivacaine versus bupivacaine for caesarean section:a meta⁃analysis[J].Int J Obstet Anesth,2016,27:9-16

    • [16] ANIM⁃SOMUAH M,SMYTH R M,CYNA A M,et al.Epi⁃ dural versus non ⁃ epidural or no analgesia for pain man⁃ agement in labour[J].Cochrane Database Syst Rev,2018,5(5):CD000331

  • 参考文献

    • [1] SIVEVSKI A,IVANOV E,KARADJOVA D,et al.Spinal⁃ induced hypotension in preeclamptic and healthy parturi⁃ ents undergoing cesarean section [J].Open Access Maced J Med Sci,2019,7(6):996-1000

    • [2] NIKOOSERESHT M,SEIF RABIEI M,HAJIAN P,et al.Comparing the hemodynamic effects of spinal anesthesia in preeclamptic and healthy parturients during cesarean section[J].Anesth Pain Med,2016,6(3):e11519

    • [3] 刘世乐,刘晓磊,陈志强,等.不同麻醉方式在剖宫产术中的应用比较[J].广东医学,2018,39(9):1283-1286

    • [4] VISALYAPUTRA S,RODANANT O,SOMBOONVI⁃ BOON W,et al.Spinal versus epidural anesthesia for ce⁃ sarean delivery in severe preeclampsia:a prospective ran⁃ domized,multicenter study[J].Anesth Analg,2005,101(3):862-868

    • [5] ZWANE S,BISHOP D,RODSETH R.Hypotension dur⁃ ing spinal anaesthesia for caesarean section in a resourcelimited setting:towards a consensus definition[J].South Afr J Anaesth Analg,2019,25(1):1-5

    • [6] CHOOI C,COX J,LUMB R,et al.Techniques for prevent⁃ ing hypotension during spinal anaesthesia for caesarean section[J].Cochrane Database Syst Rev,2020,7:CD002251

    • [7] QIAN X,WANG Q,OU X,et al.Effects of ropivacaine in patient ⁃ controlled epidural analgesia on uterine electro⁃ myographic activities during labor[J].Biomed Res Int,2018,2018:7162865

    • [8] CHUMPATHONG S,SIRITHANETBHOL S,SALAKIJ B,et al.Maternal and neonatal outcomes in women with se⁃ vere pre ⁃ eclampsia undergoing cesarean section:a 10 ⁃ year retrospective study from a single tertiary care center:anesthetic point of view[J].J Matern Fetal Neonatal Med,2016,29(24):4096-4100

    • [9] AYA A,VIALLES N,TANOUBI I,et al.Spinal anesthesia⁃ induced hypotension:a risk comparison between patients with severe preeclampsia and healthy women undergoing preterm cesarean delivery[J].Anesth Analg,2005,101(3):869-875

    • [10] KEE W,KHAW K,TAM Y,et al.Comparison of closed⁃ loop feedback computer⁃controlled and manual⁃controlled phenylephrine infusions during spinal anaesthesia for cae⁃ sarean section[J].Int J Obstet Anesth,2011,20:S17

    • [11] LAVIE A,RAM M,LEV S,et al.Maternal cardiovascular hemodynamics in normotensive versus preeclamptic preg⁃ nancies:a prospective longitudinal study using a noninva⁃ sive cardiac system(NICaSTM)[J].BMC Pregnancy Child⁃ birth,2018,18(1):229

    • [12] 王清津,刘可,蔡晓玲,等.子痫前期患者血浆儿茶酚胺与其新生儿脐血儿茶酚胺的研究[J].南方医科大学学报,2008,28(7):1309-1310

    • [13] 茆庆洪,宋娟.剖宫产腰麻痛觉阻滞平面上界的相关因素分析[J].南京医科大学学报(自然科学版),2009,29(9):1293-1295

    • [14] ROOFTHOOFT E,VAN D V M.Low ⁃dose spinal anaes⁃ thesia for caesarean section to prevent spinal⁃induced hy⁃ potension[J].Curr Opin Anaesthesiol,2008,21(3):259-262

    • [15] MALHOTRA R,JOHNSTONE C,HALPERN S,et al.Du⁃ ration of motor block with intrathecal ropivacaine versus bupivacaine for caesarean section:a meta⁃analysis[J].Int J Obstet Anesth,2016,27:9-16

    • [16] ANIM⁃SOMUAH M,SMYTH R M,CYNA A M,et al.Epi⁃ dural versus non ⁃ epidural or no analgesia for pain man⁃ agement in labour[J].Cochrane Database Syst Rev,2018,5(5):CD000331

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