本文關鍵詞：剖宮產椎管內麻醉低血壓的危險因素分析　出處：《皖南醫(yī)學院》2017年碩士論文　論文類型：學位論文

  更多相關文章： 椎管內麻醉 低血壓 剖宮產 Logistic回歸分析

【摘要】：目的分析剖宮產椎管內麻醉低血壓發(fā)生的危險因素并建立預測模型。方法隨機選取2015年11月~2016年11月在皖南醫(yī)學院附屬弋磯山醫(yī)院麻醉科行剖宮產的單胎健康產婦171名,根據(jù)剖宮產低血壓臨床調查表對產婦基本信息和各項化驗檢查結果進行記錄整理。低血壓定義為產婦在麻醉結束到胎兒娩出這段時間,出現(xiàn)收縮壓90mmHg或平均動脈壓降低≥20mmHg的為低血壓組(H組),其余定義為無低血壓組(N組),對所有納入研究的產婦年齡、基礎心率和收縮壓、妊娠前及孕晚期體重指數(shù)、孕期體重增加值、產婦宮高與腹圍、孕周、產次,麻醉方法、穿刺間隙、術前禁食時間、麻醉前補液量,胎兒超聲示雙頂徑(BPD)、胎兒股骨長度(FL)、新生兒體重,合并產婦貧血、低蛋白血癥、電解質紊亂等21項因素進行低血壓發(fā)生的相關性分析,具有統(tǒng)計學意義的因素進行二分類逐步Logistic回歸分析,并建立剖宮產椎管內麻醉低血壓發(fā)生率的預測模型,描繪受試者工作特征曲線(ROC曲線),計算ROC曲線下面積(AUC)。結果剖宮產椎管內麻醉發(fā)生低血壓79例,發(fā)生率為46.2%。單因素分析顯示高齡產婦(P=0.069)、孕婦基礎心率(P=0.001)、孕期增加體重值(P=0.046)、孕前體重指數(shù)(P=0.008)和麻醉方法(P=0.024)的組間比較差異有統(tǒng)計學意義;孕晚期體重指數(shù)、產婦宮高與腹圍、孕周、產次,穿刺間隙、術前禁食時間、麻醉前補液量,胎兒超聲示雙頂徑(BPD)、胎兒股骨長度(FL)、新生兒體重,合并產婦貧血、低蛋白血癥、電解質紊亂等因素差異無統(tǒng)計學意義。二分類Logistic回歸分析顯示:基礎心率(P=0.001)、孕期增加體重值(P=0.030)、孕前BMI(P=0.007)是低血壓發(fā)生的獨立危險因素。其Logistic回歸模型為:Y=-6.802+0.039×基礎心率+0.189×妊娠前BMI-0.080×孕期增長體重,模型預測剖宮產椎管內麻醉低血壓發(fā)生率的敏感性85.5%,特異性49.4%,AUC=0.711,95%可信區(qū)間為0.633-0.789。結論剖宮產椎管內麻醉術中低血壓的發(fā)生率較高,以基礎心率、妊娠前體重指數(shù)、孕期體重增加值建立的預測模型,對臨床預測剖宮產低血壓發(fā)生有一定指導作用。
[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.

【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614

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