胎盘体视学分析不同升压药防治剖宫产低血压的效果  

Stereological study of the placenta in patients receiving different vasopressors for hypotension during cesarean section

作　　者：徐天星[1,2] 李雅兰[3] 周锦财[1,2] 帅兵[1,2] 李艳[1,2] 麦伟图 严彦念[3] 聂偲[3] 李健玲[3] 

机构地区：[1]广州市番禺区何贤纪念医院 [2]南方医科大学附属何贤纪念医院,广东广州511400 [3]暨南大学附属第一医院,广东广州510630

出　　处：《南方医科大学学报》2014年第8期1154-1157,共4页Journal of Southern Medical University

基　　金：广东省中医药管理局科研资助项目(20121116)

摘　　要：目的运用胎盘体视学分析,研究比较多巴胺和去氧肾上腺素防治剖宫产低血压的效果,保障母婴安全。方法选择在CSEA下行剖宫产的产妇40例,随机分2组:D组(多巴胺组)和P组(去氧肾组)。腰麻注入罗哌卡因16 mg,在腰麻后即泵注升压药。术中维持血压接近基础值为原则来调整药物泵注速度。运用体视学的方法,探究胎盘绒毛微血管体积密度、长度密度的改变;查脐动脉血气;行Apgar评分;监测生命体征。结果体视学分析:D组胎盘绒毛间质微血管的体积密度小于P组,差异有统计学上的意义(P<0.05)。脐动脉血气:与P组的对比,D组的乳酸值高、pH低,差异有统计学意义(P<0.05)。两组Apgar评分和血压差异均没有统计学意义(P>0.05)。与基础HR组内比较,D组和P组HR均减慢,差异均有统计学上的意义(P<0.01)。结论多巴胺有致胎儿缺氧、酸中毒的风险,恰当微泵注射去氧肾上腺素,能很好保持产妇心率和血压的平稳、且能更好地维持胎盘微血管的血流量,减少了新生儿pH下降的风险,对母婴更安全。Objectives To study the effects of dopamine and phenylephrine for treatment of hypotension during cesarean section under combined spinal epidural anesthesia （CSEA） on the stereology of the placenta. Methods Forty puerperants undergoing cesarean section under CSEA were randomly divided into dopamine group and phenylephrine group. Ropivacaine （16 rag） was administered immediately after spinal anethesia. Blood pressure was maintained near the baseline by adjusting the drug infusion rate. Fetal blood gas, Apgar score, and placental villus microvascular stereological changes were observed during the operation. Results The microvascular density was significantly lower in dopamine group than in phenylephrine group （P〈0.05）. Phenylephrine group showed significantly lower umbilical artery blood pH than dopamine group （P〈0.05）. The Apgar score and blood pressure were comparable between the two groups （P〉0.05）. Compared to the baseline, both of the two groups showed significantly lowered heart rate during the operation （P〈0.01）. Conclusion Dopamine is associated with the risk of fetal acidosis. Phenylephrine is helpful for preventing hypotension by increasing placental blood flow and improving oxygen supply to ensure maternal and fetal safety during cesarean section.

关 键 词：剖宫产 多巴胺 去氧肾上腺素 体视学 

分 类 号：R614[医药卫生—麻醉学]