去氧肾上腺素与麻黄碱预注对腰麻下剖宫产新生儿动脉血气的影响  

Effect of pre-injection of phenylephrine versus ephedrine on arterial blood gas in neonates delivered by cesarean section under spinal anesthesia

作　　者：何鹏[1] 陈吉惠 梁永涛[1] 周述芝[1] 

机构地区：[1]雅安市人民医院麻醉科,四川雅安625000 [2]雅安市人民医院手术室,四川雅安625000

出　　处：《西南医科大学学报》2017年第6期570-573,共4页Journal of Southwest Medical University

基　　金：四川省医学会课题(S15080)

摘　　要：目的:探讨静脉注射去氧肾上腺素与麻黄碱在维持产妇血压相对不变的条件下,对腰麻下剖宫产术产妇及新生儿的影响。方法:择期在腰麻下行剖宫产产妇60例,随机分为去氧肾上腺素组(P组)和麻黄碱组(E组)。P组患者给予30 ug去氧肾上腺素后则以15 ug/min的速度持续泵注。E组患者给予静脉推注5 mg麻黄碱后以2.5 mg/min的速度持续泵注,术中调整药物输注速度以维持血压接近基础值。监测产妇入室后(T0)、给药后3、6、9、12、15、18、21、24 min(T1~T8)的SBP、HR、麻醉阻滞平面、新生儿Apgar评分。取脐带动静脉血行血气分析。并记录产妇心动过缓和恶心、呕吐等不良反应。结果:两组产妇阻滞平面,各时间点SBP,HR,不良反应差异无统计学意义(P>0.05);两组新生儿1 min和5 min Apgar评分均正常,差异无统计学意义(P>0.05),两组胎儿脐带动、静脉血PH值,PO2及PCO2差异无统计学意义(P>0.05)。结论:腰麻下剖宫产术中预防性静脉注射小剂量去氧肾上腺素或者麻黄碱后静脉泵注在维持血压相对不变的情况下,产妇呕心,呕吐发生率低,不会导致新生儿酸血症。Objective To investigate the effect of intravenously injected phenylephrine versus ephedrine on parturients undergoing cesarean section under spinal anesthesia and their neonates, with parturients＇ blood pressure maintained relatively unchanged. Methods： A total of 60 parturients who underwent selective cesarean section under spinal anesthesia were enrolled and randomly divided into phenylephrine group （group P ） and ephedrine group （group E ）. The parturients in group P were given an initial dose of 30 ug followed by continuous pumping at a rate of 15 ug/min, and those in group E were given intravenous injection of ephedrine 5 mg followed by continuous pumping at a rate of 2.5 mg/min. The infusion rate was adjusted during surgery to maintain blood pressure around the baseline value. Systolic blood pressure （SBP） and heart rate （HR） were monitored for all parturients after entrance to the operating room （ T0） and at 3, 6, 9, 12, 15, 18, 21, and 24 minutes after administration （ T 1-T8）, the block level of spinal anesthesia was evaluated for all parturients, and the Apgar score was determined for all neonates. Blood samples were collected from the umbilical artery and vein to perform the blood -gas analysis. Adverse reactions in parturients including bradycardia, nausea, and vomiting were recorded. Results： There were no significant differences in the block level of spinal anesthesia and SBP and HR at all time points between the two groups （P 〉 0.05）. Both groups of neonates had a normal Apgar score at 1 and 5 minutes, and there were no significant differences between the two groups （P 〉 0.05）. There were also no significant differences in pH, partial pressure of oxygen, and partial pressure of carbon dioxide in the umbilical artery and vein between the two groups of fetuses （P 〉 0.05）. Conclusions： Prophylactic intravenous injection of low -dose phenylephrine or ephedrine followed by intravenous pumping in cesarean

关 键 词：剖宫产 胎儿pH 蛛网膜下腔阻滞 缩血管药 去氧肾上腺素 

分 类 号：R614.41[医药卫生—麻醉学]