预注不同血管活性药对重度子痫前期患者腰硬联合麻醉剖宫产母儿的影响  

Effects of pretreatment with phenylephrine and ephedrine on maternal and neonate in combined spinal-epidural anesthesia for cesarean section of patient with severe preeclampsia

作　　者：蔡恒宇[1] 郜红艳[1] 

机构地区：[1]沈阳市妇婴医院麻醉科,沈阳110011

出　　处：《实用药物与临床》2014年第10期1258-1261,共4页Practical Pharmacy and Clinical Remedies

基　　金：沈阳市卫生局科研基金资助项目

摘　　要：目的观察预注不同血管活性药对重度子痫前期患者腰硬联合麻醉剖宫产母儿的影响。方法择期拟联合阻滞麻醉下剖宫产术的重度子痫前期产妇60例,随机均分为3组,E组泵入麻黄素(2 mg/min),P组泵入去氧肾上腺素(25μg/min),C组泵注同等容量的生理盐水。调整药物输注量维持血压接近术前基础值的80%。记录三组药物的使用容量、输注血管收缩药后1、3、5、7、10、12、15 min的MAP、HR,同时记录产妇恶心、呕吐的情况。在胎儿娩出即刻,进行产妇动脉血、新生儿脐动脉和脐静脉血气分析,对新生儿进行1 min和5 min Apgar评分。结果母体术中HR变化:用药后5 min,P组与E组比较差异有统计学意义;用药后3 min,P组与C组比较差异有统计学意义;用药后3、5 min,E组与C组比较差异有统计学意义。母体术中MAP变化:用药后3、5、7 min,P组与C组、E组与C组比较差异有统计学意义。C组产妇中恶心呕吐的发生率与P组、E组比较差异有统计学意义。C组麻黄碱追加次数与P组、E组比较差异有统计学意义。结论 CSEA麻醉前预先给予去氧肾上腺素、麻黄碱等血管活性药物并维持一定的血药浓度,对维持重度子痫患者的血流动力学稳定、改善患者及胎儿的预后有一定意义。Objective To observe the effects of pretreatment with phenylephrine and ephedrine on MAP,HR of maternal and neonate during combined spinal-epidural anesthesia for cesarean section with severe preeclampsia.Methods 60 parturients with severe preeclampsia,ASAⅡ -Ⅲ,under combined spinal-epidural anesthesia for cesarean section were equally randomized into phenylephrine group（group P,25 μg /min,n = 20）,ephedrine group（group E,2 mg /min,n = 20） and control group（ group C,normal saline,n = 20）. 0. 5% bupivacaine 6. 0 mg was given through subarachnoid space after successfully puncturing in L2 -3 intervertebral space. Blood pressure was maintained near80% baseline by adjusting the drug infusion rate. MAP and HR were monitored at the time points of 1,3,5,7,10,12,15 min after drug administration,and vomiting and dizziness were recorded. Blood samples of maternal artery,umbilical artery and vein were collected immediately after delivery for blood gas analysis and detection of lactate and glucose and Apgar score of neonate was assessed. Results The HR in group P was lower than that of group E at the time points of5,7,10,12,15 min and that of group C at the time points of 3,5,7,10,12,15 min. The MAP in group P was higher than that of group C at the time points of 3,5,7 min,and the MAP in group E was higher than that of group C at the time points of 3,5,7 min. The incidences of vomiting and dizziness in group P and group E were lower than those of group C. Conclusion It is an effective measurement to stable maternal hemodynamics and improve the prognosis with phenylephrine and ephedrine on maternal and neonate during combined spinal epidural anesthesia for cesarean section with severe preeclampsia.

关 键 词：重度子痫前期 腰硬联合麻醉 去氧肾上腺素 麻黄碱 剖宫产 

分 类 号：R614[医药卫生—麻醉学]