胶体液预扩容联合预输注不同小剂量血管活性药物对蛛网膜下腔阻滞下行二次剖宫产术产妇和新生儿的影响  

Effect of colloidal pre-infusion combined with different vasoactive drugs on puerperants and neonates during spinal anesthesia for the second cesarean section

作　　者：洪蕾 罗文杰[2] 张琳玲 李玉莲 HONG Lei;LUO Wenjie;ZHANG Linling;LI Yulian(Department of Anesthesiology,Shanghai Songjiang District Maternal and Child Health Hospital,Shanghai 201620, China;不详)

机构地区：[1]上海市松江区妇幼保健院麻醉科,上海201620 [2]上海市普陀区人民医院麻醉科

出　　处：《上海医学》2020年第3期184-188,共5页Shanghai Medical Journal

基　　金：上海市松江区科学技术攻关项目(16SJGG42)

摘　　要：目的观察胶体溶液预扩容联合预输注不同小剂量血管活性药物对蛛网膜下腔阻滞下行二次剖宫产术的产妇和新生儿的影响。方法选择择期行二次剖宫产术的产妇180例,采用随机数字表法分为去甲肾上腺素组、去氧肾上腺素组、麻黄素组,每组60例。所有患者均于麻醉前以滴速10 mL/(kg·h)持续静脉滴注6%羟乙基淀粉(130/0.4)预扩容30 min,再以10 mL/(kg·h)乳酸钠林格注射液维持。麻醉后各组分别经静脉泵注射血管活性药物去甲肾上腺素5μg/(mL·min)、去氧肾上腺素50μg/(mL·min)、麻黄素8 mg/(mL·min),持续时间均为1 min。记录3组产妇在麻醉前(T0)、麻醉后1 min(T1)、麻醉后5 min(T2)、胎儿娩出时(T3)和出手术室时(T4)的血流动力学指标[收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率],记录3组新生儿出生后1、5 min Apgar评分和娩出即刻脐动脉血血气分析指标[pH值、paO2、paCO2、碱剩余(BE)]。记录产妇术中不良反应(低血压、心动过缓、心动过速和恶心呕吐),以及新生儿加压给氧和气管插管情况。结果3组T1至T4时间点的SBP、DBP、MAP与同组T0时间点的差异均无统计学意义(P值均>0.05)。去氧肾上腺素组T1至T3时间点的心率均显著慢于同组T0时间点(P值均<0.05),T4时间点的心率与同组T0时间点的差异无统计学意义(P>0.05)。麻黄素组T1、T2时间点的心率均显著快于同组T0时间点(P值均<0.05),T3时间点的心率显著慢于同组T0时间点(P<0.05);T4时间点的心率与同组T0时间点的差异无统计学意义(P>0.05)。去甲肾上腺素组T1至T4时间点的心率与同组T0时间点的差异均无统计学意义(P值均>0.05)。3组产妇术中低血压、心动过缓、心动过速和恶心呕吐发生率的差异均无统计学意义(P值均>0.05)。3组术中单次泵注血管活性药物有效率、追加1次血管活性药物患者比例,以及术中阿托品1次用药、2次用药患者比例的差异均无�Objective To observe the effect of colloidal pre-infusion combined with different low-dose vasoactive drugs on puerperants and neonates during spinal anesthesia for second cesarean section. Methods A total of 180 puerperants scheduled for the second cesarean section were randomly divided into 3 groups(n=60): norepinephrine group, phenylephrine group, and ephedrine group. All the patients were given 6% hydroxyethyl starch(130/0.4) injection(10 mL/[kg·h]) 30 min before anaesthesia, followed by lactate ringer’s solution [10 mL/(kg·h)] for the maintenance of anaesthesia. After spinal anesthesia, norepinephrine(5 μg/[mL·min]), phenylephrine(50 μg/[mL·min]) and ephedrine(8 mg/[mL·min]) were infused by pump for 1 min, respectively. Puerperants’ hemodynamics, such as systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP) and heart rate(HR), were measured before anesthesia(T0), after 1 min(T1), 5 min(T2) of anesthesia, at delivery(T3), and out of room(T4). Apgar scores at 1 min and 5 min after delivery and parameters of umbilical arterial blood gas analysis(pH, paO2, paCO2, base excess [BE]) were recorded. Adverse reactions, such as hypotension, bradycardia, tachycardia, nausea and vomiting in puerperants during the section, and oxygen delivery and tracheal intubation in neonates were also recorded. Results SBP, DBP and MAP from T1 to T4 were not significantly different from those at T0 in any group(all P>0.05). HR from T1 to T3 was significantly lower than that at T0 in phenylephrine group(all P<0.05), but HR at T4 was not significantly different from that at T0 (P>0.05). In ephedrine group, compared to that at T0, HR was significantly increased at T1 and T2(both P<0.05), decreased at T3(P<0.05), but not significantly changed at T4(P>0.05). No significant change was found in HR during the operation in norepinephrine group(all P>0.05). There were no significant differences in the incidence of hypotension, bradycardia, tachycardia, nausea or vomiting among the three groups(all P

关 键 词：去甲肾上腺素 去氧肾上腺素 麻黄素 蛛网膜下腔阻滞 二次剖宫产术 血气分析 

分 类 号：R614[医药卫生—麻醉学]