预负荷/共同负荷联合血管收缩药对腰麻剖宫产术血流动力学变化  

Changes of preload/coload combined with vasoconstrictors on maternal hemodynamics during spinal anesthesia for cesarean section

作　　者：武伟[1] 谭宪湖[1] 蒋卓迅[1] 林育南[1] 何亚军[1] 黄佳洋[1] 宋恺颖[1] 杨肖[1] 

机构地区：[1]广西医科大学第一附属医院麻醉科,广西南宁530021

出　　处：《蛇志》2011年第4期351-352,362,共3页Journal of Snake

基　　金：广西区卫生厅自筹科研课题项目(Z2011353)

摘　　要：目的探讨预负荷/共同负荷联合小剂量血管收缩药盐酸麻黄碱注射液(上海信谊金朱药业有限公司)、盐酸去氧肾上腺素注射液(上海禾丰制药有限公司)对腰麻剖宫产术中血流动力学的变化及预防低血压的有效性及安全性。方法选择剖宫产术90例,随机分为3组,每组30例。ASA I～Ⅱ级。预负荷晶体液乳酸林格氏注射液(石家庄西药有限公司)6～8ml/kg联合共同负荷输入羟乙基淀粉130/0.4氯化钠溶液(万汶,北京费森尤斯卡比医药有限公司)10ml/kg。术中监测记录SBP、DBP、HR、ECG、SpO2。结果预负荷/共同负荷联合血管收缩药预防剖宫产术腰麻后低血压,P组和E组的低血压发生率明显低于C组(P<0.05);P组术中HR低于E组和C组。预防恶心、呕吐给于盐酸昂丹司琼注射液(齐鲁制药有限公司),不良反应少,无明显呼吸抑制、无术后头痛现象。结论预负荷/共同负荷联合小剂量血管收缩药,有效降低腰麻后低血压的发生率,去氧肾上腺素比麻黄碱能更好维持产妇血流动力学的稳定。对新生儿无不良影响,安全。Objective To study changes on maternal hemodynamics and the efficacy and safety in prevention of hypotension of preload/coload combined with low dose of vasoconstrictor： ephedrine hydrochloride injection or phenylephrine hydrochloride injection during spinal anesthesia for cesarean section. Methods Ninety cases of cesarean section（ASA I to II ）were randomly divided into three groups with 30 cases each： Phenylephrine group（group P） ;ephedrine group（group E）and the control group（group C）. Lactated Ringer＇s solution were injected before induction of spinal anesthesia with 6-8 ml/kg（preload） and Hydroxyethyl Starch 130/0. 4 and Sodium Chloride solution were injected at the time of induction of spinal anesthesia （coload） with 10 ml/kg. SBP, DBP, HR, ECG, SpOz were recorded. Results The incidences of maternal hypotension in group P and group E was significantly lower than those in group C （P〈0. 05）. The values of maternal heart rate in group P were lower than those in group E and group C（P〈0.05）. Ondansetron Hydrochloride Injection which was used to prevent nausea and vomiting had few adverse reactions： significant respiratory depression, postoperative headache. Conclusion Preload/coload combined with low dose of vasoconstrictor can effectively reduce the incidence of maternal hypotension after spinal anesthesia for cesarean section; ephedrine was better than phenylephrine to maintain maternal hemodynamic stability. Ephedrine had no adverse effects on newborns and it was safe.

关 键 词：预负荷/共同负荷 麻黄碱 去氧肾上腺素 腰麻 血流动力学 

分 类 号：R719.8[医药卫生—妇产科学]