腰麻剖宫产手术预注去氧肾上腺素对母婴的影响  

The Research on Effect of Phenylephrine in Spinal Anaesthesia on Parturients and Newborns for Caesareml Delivery

作　　者：张兴[1] 张旭丽[1] 

机构地区：[1]广西钦州市第一人民医院,钦州535099

出　　处：《中国现代手术学杂志》2016年第2期141-144,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨腰麻剖宫产手术预注去氧肾上腺素对母婴的影响。方法选择2013年6月至2015年6月间我院行腰麻剖宫产产妇76例,随机分为观察组与对照组。产妇腰麻改平卧位后观察组即刻静脉推注去氧肾上腺素60μg,对照组静脉推注麻黄碱5 mg。记录入室后（T1）、腰麻后1 min（T2）和5 min（T3）及胎儿娩出前1 min（T4）、娩出后3 min（T5）、10 min（T6）的收缩压（systolic blood pressure,SBP）、舒张压（diastolic blood pressure,DBP）、心率（HR）,记录围术期产妇恶心呕吐等不良反应的发生情况。记录胎儿脐动脉血的血气指标（p H、Pa O2、Pa CO2、BE）和脐静脉血的血糖和乳酸浓度,由新生儿科医生对新生儿进行Apgar评分（1 min、5 min）。结果观察组新生儿脐静脉血的血糖和乳酸水平略低于对照组,但是比较差异无统计学意义（P〉0.05）。两组新生儿脐动脉血的血气指标p H值、BE、Pa CO2比较均无显著差异（P〉0.05）。与观察组比较,对照组的HR在T2-T6时间点明显加快,差异具有统计学意义（P〈0.05）;对照组的HR在T2-T6时间点与同组T1时比较亦明显加快,差异具有统计学意义（P〈0.05）。T1-T6时两组产妇的SBP和DBP组内、组间比较均无明显差异（P〉0.05）。观察组产妇恶心呕吐的发生率明显低于对照组,差异具有统计学意义（P〈0.05）;而两组产妇头晕、胸闷以及低血压的发生率比较无明显差异（P〉0.05）。两组新生儿的Apgar评分无明显差异（P〉0.05）。结论腰麻剖宫产手术预注去氧肾上腺素能较好地防治产妇术中低血压,有效降低产妇不良反应的发生,而且对新生儿无不良影响,值得临床推广。Objective To discuss the effect of phenylephrine in spinal anaesthesia on parturients and newborns for Caesarean delivery. Methods 76 parturients from January 2013 to June 2015 in our hospital undergoing caesarean delivery were randomly divided into two groups,the observation group and control group,with 38 cases for each. After spinal anaesthesia finished,60 μg of phenylephrine was intravenously injected instantly in the observation group,and 5 mg of ephedrine was intravenously injected instantly in the control group. SBP,DBP,HR and the adverse reaction rate of the parturients were recorded before anesthesia（ T1）,1 minute after spinal anaesthesia（ T2）,5 minutes after spinal anaesthesia（ T3）,1 minute before delivery（ T4）,3 minutes after delivery（ T5） and 10 minutes after delivery（ T6）. The Apgar scores of the infants were also recorded at 1 minute and 5 minutes after delivery. The blood gas analysis of umbilical artery was analyzed,such as pH,PaO2,PaCO2 and BE. Results The blood glucose and lactic acid level of the infants in the observation group was slightly lower than the control group,but there was no statistical significance（ P〈0. 05）.And there was no different of the blood gas analysis of umbilical artery between the two groups（ P〉0. 05）. But the heart rate of control group during T2 - T6 was quicker than that of the observation group（ P〈0. 05）,and also quicker than that of T1 in itself（ P〈0. 05）. There was no difference between the two groups of SBP and DBP. The occurrence of nausea and vomiting in control group was higher than observation group（ P〈0. 05）. No significant difference exited in the 1-mimute and 5-minute Apgar value of newborns between the two group. Conclusion Phenylephrine in spinal anaesthesia is superior to ephedrine with low adverse reaction rate of the parturients and no influence on the newborns.

关 键 词：去氧肾上腺素 剖宫产 腰麻 新生儿 

分 类 号：R614[医药卫生—麻醉学]