昂丹司琼联合晶体液快速输注对剖宫产术中产妇和胎儿的影响  

Fetal and maternal effects of prophylactic intravenous ondansetron combined rapid crystalloid co-load during spinal anesthesia for cesarean delivery

作　　者：王猛[1] 沈明坤[1] 王群[1] 余燕云[1] 郁君静[1] 

机构地区：[1]南京医科大学附属无锡妇幼保健院麻醉科,无锡市214002

出　　处：《临床麻醉学杂志》2013年第8期761-764,共4页Journal of Clinical Anesthesiology

基　　金：无锡市卫生局科技项目(面上项目)(项目编号:ML201205)

摘　　要：目的探讨脊麻前预注昂丹司琼联合脊麻后晶体液快速输注预防脊麻下剖宫产术中低血压的效果以及对产妇和胎儿的影响。方法拟择期在脊麻下行剖宫产手术的单胎足月妊娠产妇60例,随机分为两组,分别在脊麻前5min静脉推注昂丹司琼4mg(O组)或生理盐水5ml(S组),脊麻注药后立即快速输注复方乳酸钠。从注药后2min开始,每隔2分钟测量并记录BP、HR和SpO2,直至鞘内注药30min。胎儿娩出后即刻取胎儿脐动脉和脐静脉血行血气分析。结果 O组产妇术中低血压和恶心的发生率明显低于S组(P<0.01)。O组胎儿脐静脉血的pH明显高于S组(P<0.05),PCO2明显低于S组(P<0.05)。O组产妇术中SBP下降幅度明显小于S组(P<0.05)。结论脊麻前静注昂丹司琼联合脊麻后晶体液快速输注可以明显减少产妇脊麻后低血压和恶心的发生,从而改善脐静脉的酸碱状态,减少血管收缩药的使用,但不影响产妇舒张压和心率。Objective To investigate the fetal and maternal effects of prophylactic intravenous ondansetron combined rapid crystalloid co-load to prevent the hypotension during spinal anesthesia for cesarean delivery. Methods Sixty mature panurient women with single-embryo scheduled for elective caesarean section were randomly divided into two groups and respectively injected ondansetron 4 mg （group O） or saline 5 ml（group S） 5 rain before spinal anesthesia. Rapid crystalloid infusion was given by fully opening the clamp of the infusion administration set immediately after intrathecal injection. The maternal BP, HR and SpO2 were measured at 2 min intervals beginning 2 min after spinal injection until 30 min after intrathecal injection. Immediately after delivery, umbilical arterial and umbilical venous blood samples were withdrawn for the measurements of blood gases. Results The incidence of hypotension and nausea in group O were lower than those in group S （P〈~0. 01）. The pH values of umbilical venous in group O were higher than in group S（P〈0. 05）, while the PCOz values were lower（P〈0. 05）. The decrease of SBP was lower in group O（P〈0. 05）. The consumption of phenylephrine in group O was lower compared with group S （P 〈 0. 05 ）. Conclusion Intravenous ondansetron before spinal anesthesia combined rapid crystalloid cotoad after intrathecal injection can significantly reduce the drop of maternal systolic blood pressure after spinal anesthesia, reduce the incidence of maternal hypotension and nausea, thereby improve the acid-base status of umbilical vein, reduce the use of vasoconstrictor, but does not affect diastolic blood pressure and heart rate

关 键 词：昂丹司琼 低血压 脊麻 剖宫产 

分 类 号：R614[医药卫生—麻醉学]