月经周期对腰硬联合麻醉患者循环功能的影响
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Effect of the menstrual cycle on circulation during combined spinal-epidural anaesthesia
背景与目的
周期性波动的激素水平影响子宫内膜，使月经周期分为三个阶段：月经期、卵泡期和黄体期。从青春期到更年期，月经周期中的激素水平可影响心血管系统、水电解质平衡等全身各系统。以往的研究主要关注雌激素和孕激素对心血管系统的影响，而激素水平对体位改变或麻醉过程中循环的影响尚未报道。本研究旨在观察月经周期不同阶段对体位改变和腰硬联合麻醉 (CSEA)时循环功能的影响。
方 法
46例ASA I-II级且符合试验标准的择期妇科手术患者，分为卵泡期组和黄体期组。术前测量仰卧位和站立位的心率、血压，入室时、腰硬联合麻醉开始前及麻醉后10min、20min、30min测量心率、收缩压、舒张压和平均动脉压。
结 果
黄体期组患者麻醉前、后的心率均高于卵泡期组（P < 0.05）。腰硬联合麻醉后前30min，黄体期组麻黄碱的使用量明显多于卵泡期组（P <0.05）。
结 论
尽管影响轻微，但卵泡期患者较黄体期能更大程度抵消和耐受循环波动。
原始文献摘要
Hua L,Wen-zhi L.Effect of the menstrual cycle on circulation during combined spinal-epidural anaest hesia[J].BMC Anesthesiology,2018,18(1):109.
Background: From adolescence to menopause, hormone levels during the menstrual cycle affect various body systems, from the cardiovascular system to the water and electrolyte balance. This study investigated the effect of different phases of the menstrual cycle on circulatory function relative to changes in body position and combined spinal-epidural anaesthesia (CSEA).
Methods: Forty-six women were selected who underwent scheduled gynaecological surgery, were classified as American Society of Anesthesiology (ASA) I-II, and met the test criteria. The sample was divided into the f ollicular and corpus luteal groups. Preoperative heart rate and blood pressure measurements were taken f rom the supine and standing positions. Heart rate measurements as well as systolic,diastolic, and mean blood pressure measurements were taken upon entering the operating room, at the beginning of the spinal-epidural anaesthesia, and 10, 20, and 30 min after anaesthesia was administered.
Results: The heart rates of patients in the corpus luteal group were higher than those of patients in the follicular group both bef ore and after anaesthesia (P < 0.05). Significantly more ephedrine was used during the first 30 min of CSEA in the corpus luteal group than in the follicular group (P < 0.05).
Conclusions: Although the eff ect was slight, women in the follicular phase were better able to compensate and tolerate circulatory fluctuations than those in the luteal phase.
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