不同方法预防脊麻后低血压对剖宫产产妇及新生儿的影响  

The effects of different methods in the preventing of hypotension during spinal anesthesia for cesarean section

作　　者：王文凯 曾慧琳 冯淑娜 詹伦娟 叶露[4] 陈慧琦[4] 

机构地区：[1]广东省惠州市第一妇幼保健院麻醉科,广东惠州516001 [2]广东省惠州市第一妇幼保健院妇产科,广东惠州516001 [3]广东省惠州市惠阳区妇幼保健院妇产科,广东惠州516000 [4]广东省惠州市惠阳区妇幼保健院麻醉科,广东惠州516000

出　　处：《中国医药导报》2011年第10期86-88,共3页China Medical Herald

基　　金：广东省惠州市科技局科研立项项目(项目名称:不同方法预防脊麻后低血压对剖宫产产妇及新生儿的影响;项目编号:2010Y106)

摘　　要：目的:比较麻醉前预先输注胶体液扩容和脊麻后立即给予麻黄素或苯肾上腺素预处理三种方法在预防剖宫产产妇低血压的有效性以及新生儿安全性方面的差异。方法:选择ASAⅠ～Ⅱ级的择期剖宫产患者180例,随机分成三组,每组60例,万汶组(V组)、麻黄素组(E组)和苯肾上腺素组(P组)。V组麻醉前预输注万汶10 ml/kg,术中以平衡液10 ml/(kg.h)维持;E组和P组麻醉开始前即以平衡液10 ml/(kg.h)维持,在腰麻药推注的同时分别以5 mg/min和50μg/min的速度泵注麻黄素和苯肾上腺素2 min,之后所有患者若出现低血压给予麻黄素10 mg静注处理。观察并记录各组患者麻醉前及术中的血压、心率,追加麻黄素的总量,新生儿脐动脉血气分析结果和胎儿娩出后1 min和5 min Apgar评分。结果:三组患者术前血压的基础值及术中血压的最高值差异无统计学意义(P>0.05);E组和P组的最低收缩压、血压下降幅度明显小于V组,E组和P组追加麻黄素的总量明显少于V组(P<0.05),E组和P组间比较差异无统计学意义(P>0.05);E、P组无反应性高血压和心动过缓。新生儿脐动脉血pH值、PaO2及BE值P组明显高于V组和E组(P<0.05),V、E两组间差异无统计学意义(P>0.05)。1 min和5 min Apgar评分三组间差异无统计学意义(P>0.05)。结论:用麻黄素或苯肾上腺素预处理比麻醉前预先应用胶体液扩容的方法更能有效地预防剖宫产患者脊麻后的低血压,但在维持胎儿酸碱平衡稳定方面,苯肾上腺素则更好。Objective：To study the safety of Ephedrine,Phenylephrine or preloading hydroxyethyl starch for treatment of spinal anesthesia induced hypotension during cesarean section,and to provide the evidence to select the solution administ ration during anesthesia.Methods：180 ASA physical status Ⅰ and Ⅱ patients scheduled for caesarean section were randomly divided into three groups,the hydroxyethyl starch preloading group（V group）,Ephedrine group（E group）,Phenylephrine group（P group）.V group preloaded hydroxyethyl starch 10 ml/kg before anesthesia.The other two groups were administrated the lactated Ringer’s 10 ml/（kg·h） during the operation.After intrathecal injection,E group infused ephedrine 5 mg/min and P group infused phenylephrine 5 mg/min for 2 min.If hypotension appeared,Ephedrine 10 mg was administrated.The parturient SBP,DBP and HR were monitored,fetal Apgar score,umbilical arterial blood gases and total dose of additional ephedrine were recorded.Results：The pressure before anesthesia was similar between three groups.Compared with V group,the decrease of blood pressure was lower in E group and P group（P〈0.05）,the total dose of Ephedrine was lower in E group and P group（P〈0.05）.Compared with P group,pH,PaO2 and base excess of umbilical arterial blood gases were lower in V group and E group（P〈0.05）.No statistical differences were found in Apgar score between three groups.Conclusion：Phenylephrine or Ephedrine given by infusion to maintain arterial blood pressure during spinal anesthesia for cesarean delivery were more effective than preloading hydroxyethyl starch before anesthesia.But giving Phenylephrine by infusion at cesarean secotion was associated with a lower incidence of fetal acidosis.

关 键 词：脊麻 剖宫产 低血压 羟乙基淀粉 麻黄素 苯肾上腺素 

分 类 号：R614[医药卫生—麻醉学]