剖宫产椎管内麻醉低血压的危险因素分析

发布时间：2018-01-16 04:31

本文关键词：剖宫产椎管内麻醉低血压的危险因素分析　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的分析剖宫产椎管内麻醉低血压发生的危险因素并建立预测模型。方法随机选取2015年11月~2016年11月在皖南医学院附属弋矶山医院麻醉科行剖宫产的单胎健康产妇171名,根据剖宫产低血压临床调查表对产妇基本信息和各项化验检查结果进行记录整理。低血压定义为产妇在麻醉结束到胎儿娩出这段时间,出现收缩压90mmHg或平均动脉压降低≥20mmHg的为低血压组(H组),其余定义为无低血压组(N组),对所有纳入研究的产妇年龄、基础心率和收缩压、妊娠前及孕晚期体重指数、孕期体重增加值、产妇宫高与腹围、孕周、产次,麻醉方法、穿刺间隙、术前禁食时间、麻醉前补液量,胎儿超声示双顶径(BPD)、胎儿股骨长度(FL)、新生儿体重,合并产妇贫血、低蛋白血症、电解质紊乱等21项因素进行低血压发生的相关性分析,具有统计学意义的因素进行二分类逐步Logistic回归分析,并建立剖宫产椎管内麻醉低血压发生率的预测模型,描绘受试者工作特征曲线(ROC曲线),计算ROC曲线下面积(AUC)。结果剖宫产椎管内麻醉发生低血压79例,发生率为46.2%。单因素分析显示高龄产妇(P=0.069)、孕妇基础心率(P=0.001)、孕期增加体重值(P=0.046)、孕前体重指数(P=0.008)和麻醉方法(P=0.024)的组间比较差异有统计学意义;孕晚期体重指数、产妇宫高与腹围、孕周、产次,穿刺间隙、术前禁食时间、麻醉前补液量,胎儿超声示双顶径(BPD)、胎儿股骨长度(FL)、新生儿体重,合并产妇贫血、低蛋白血症、电解质紊乱等因素差异无统计学意义。二分类Logistic回归分析显示:基础心率(P=0.001)、孕期增加体重值(P=0.030)、孕前BMI(P=0.007)是低血压发生的独立危险因素。其Logistic回归模型为:Y=-6.802+0.039×基础心率+0.189×妊娠前BMI-0.080×孕期增长体重,模型预测剖宫产椎管内麻醉低血压发生率的敏感性85.5%,特异性49.4%,AUC=0.711,95%可信区间为0.633-0.789。结论剖宫产椎管内麻醉术中低血压的发生率较高,以基础心率、妊娠前体重指数、孕期体重增加值建立的预测模型,对临床预测剖宫产低血压发生有一定指导作用。
[Abstract]:Objective to analyze the cesarean section of spinal anesthesia risk factors of hypotension and to establish prediction model. Methods from November 2015 ~2016 year in November the Department of anesthesia for cesarean section in single fetal maternal health 171 in Wangnan Medical College affiliated yijishan hospital were randomly selected, according to the cesarean section on maternal hypotension clinical questionnaire of basic information and the test results documenting. Maternal hypotension was defined as at the end of anesthesia to the fetus during this period of time, systolic blood pressure and mean arterial pressure decreased 90mmHg or greater than 20mmHg for hypotension group (H group), the other is defined as no hypotension group (N group), all included in the study of maternal age, heart rate and systolic blood pressure, pregnancy before and during late pregnancy BMI, gestational weight gain, maternal uterine height and abdominal circumference, gestational age, parity, anesthesia, puncture clearance, preoperative fasting time before anesthesia, transfusion volume, fetal biparietal ultrasonography The diameter (BPD), fetal femur length (FL), with birth weight, maternal anemia, hypoproteinemia, electrolyte disorder and other 21 factors associated hypotension, stepwise Logistic regression analysis of two classification factors has statistical significance, and establish the prediction model of cesarean section rate of hypotension of spinal canal. Receiver operating characteristic curve (ROC curve), calculation of the area under the ROC curve (AUC). The results of cesarean section in 79 cases of spinal anesthesia hypotension, the incidence rate was 46.2%. univariate analysis showed that maternal age (P= 0.069), heart rate (P=0.001), maternal pregnancy weight value (P=0.046), pre pregnancy body mass index (P=0.008) and anesthesia (P=0.024) the difference between groups was statistically significant; late pregnancy body mass index, maternal uterine height and abdominal circumference, gestational age, parity, puncture clearance, preoperative fasting time before anesthesia, transfusion volume, fetal ultrasound Show the biparietal diameter (BPD), fetal femur length (FL), with birth weight, maternal anemia, hypoproteinemia, no statistically significant difference between electrolyte disorders and other factors. Two classification Logistic regression analysis showed that: the basic heart rate (P=0.001), pregnancy weight gain value (P= 0.030), before BMI (P=0.007) is an independent risk factors of hypotension. The Logistic regression model: Y=-6.802+0.039 * +0.189 * BMI-0.080 basic heart rate before pregnancy * pregnancy weight growth model, cesarean section spinal anesthesia hypotension rate sensitivity of 85.5%, specificity of 49.4%, AUC=0.711,95% CI 0.633-0.789. conclusion cesarean section intraspinal anesthesia in the incidence of hypotension is high, on the basis of heart rate, body mass index before pregnancy, pregnancy weight to increase the value of the model, to the clinical prediction of cesarean section hypotension has a certain guiding role.

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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