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Effect of the menstrual cycle on circulation during combined spinal-epidural anaesthesia
背景與目的
周期性波動的激素水平影響子宮內(nèi)膜，使月經(jīng)周期分為三個階段：月經(jīng)期、卵泡期和黃體期。從青春期到更年期，月經(jīng)周期中的激素水平可影響心血管系統(tǒng)、水電解質(zhì)平衡等全身各系統(tǒng)。以往的研究主要關(guān)注雌激素和孕激素對心血管系統(tǒng)的影響，而激素水平對體位改變或麻醉過程中循環(huán)的影響尚未報道。本研究旨在觀察月經(jīng)周期不同階段對體位改變和腰硬聯(lián)合麻醉 (CSEA)時循環(huán)功能的影響。
方 法
46例ASA I-II級且符合試驗(yàn)標(biāo)準(zhǔn)的擇期婦科手術(shù)患者，分為卵泡期組和黃體期組。術(shù)前測量仰臥位和站立位的心率、血壓，入室時、腰硬聯(lián)合麻醉開始前及麻醉后10min、20min、30min測量心率、收縮壓、舒張壓和平均動脈壓。
結(jié) 果
黃體期組患者麻醉前、后的心率均高于卵泡期組（P < 0.05）。腰硬聯(lián)合麻醉后前30min，黃體期組麻黃堿的使用量明顯多于卵泡期組（P <0.05）。
結(jié) 論
盡管影響輕微，但卵泡期患者較黃體期能更大程度抵消和耐受循環(huán)波動。
原始文獻(xiàn)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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