麻黄碱预处理对蛛网膜下腔阻滞剖宫产的血压影响  

Effects of Ephedrine Pretreatment on Blood Pressure During Spinal Anesthesia for Cesarean Section

作　　者：黄仰发[1] 曾邦伟[1] 黄其健[1] 曾健[1] 许小平 李玉梅[1] 翁险峰[1] HUANG Yangfa;ZENG Bangwei;HUANG Qijian;ZENG Jian;XU Xiaoping;LI Yumei;WENG Xianfeng(Department of Anesthesiology,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院麻醉科,福州350001

出　　处：《福建医科大学学报》2018年第6期416-420,共5页Journal of Fujian Medical University

基　　金：福建省科技软科学项目(2018R0042);福建省卫计委青年科研课题(2015-1-36)

摘　　要：目的观察麻黄碱预处理对蛛网膜下腔阻滞(脊麻)剖宫产手术期间血压的影响。方法 120例ASAⅠ～Ⅱ级的择期行剖宫产术的单胎足月产妇,随机分成对照组和研究组,各60例。于L_(3～4)间隙行腰-硬联合穿刺,蛛网膜下腔注入等比重的布比卡因(0.5%,10 mg)。研究组在蛛网膜下腔注射药物、左倾体位回正、胎儿取出的同时静脉注射0.1 mg/kg麻黄碱,对照组按常规处理。观察记录4个时间期的最低收缩压(SBP):T_0(入室后麻醉开始前),T_1(蛛网膜下腔注射药物完毕后5 min内),T_2(左倾体位回正后5 min内),T_3(胎儿取出后5 min内);新生儿出生后行脐动脉血气分析,记录1,5,10 min的新生儿Apgar评分;记录产妇麻醉术中麻黄碱及阿托品用量、出血量、尿量、低血压及恶心、呕吐等不良反应发生情况。结果 2组SBP的血压下降值在T_1,T_2及T_3 3个时间期与T_0比较,差别均有统计学意义(P<0.001);2组新生儿脐动脉血气分析结果及Apgar评分比较,差别无统计学意义(P>0.05);T_1,T_2及T_3 3个时间期2组恶心呕吐严重程度比较,差别均有统计学意义(P<0.001)。结论 T_1,T_2,T_3是剖宫产期间易出现低血压的时间,恶心、呕吐发生率高;予麻黄碱提前干预后血流动力学更平稳,恶心、呕吐的发生率明显降低。Objective To analyze the effects of ephedrine pretreatment on blood pressure during spinal anesthesia for Cesarean section.Methods 120 women with singleton pregnancy at term,who were graded American Society of Anesthesiologists statusesⅠorⅡand who were undergoing elective Cesarean section,were included in this study.The selected women were randomly divided into control group and test group(each n=60).All women underwent puncture at the L3~4 interspace using the combined spinal epidural technique;isobaric bupivacaine(0.5%,10 mg)was injected into the subarachnoid space.In the test group,0.1 mg/kg ephedrine was administered intravenously while the subarachnoid injection,recovery from left lateral tilt position,and fetal delivery was carried out.The conventional treatment was carried out in the control group.The lowest systolic blood pressure values(SBP)during four time periods were observed and recorded:T0,entry into the operating room and before anesthesia;T1,within 5 minutes after subarachnoid drug injection;T2,within 5 min after recovery from left lateral tilt position;T3,within 5 minutes after delivery;umbilical artery blood gases analysis was performed after birth.Apgar scores was recorded at 1 min,5 min and 10 min;dosage of ephedrine and atropine,intraoperative blood loss,urine volume,hypotension,nausea,vomiting,and incidences of other adverse events were recorded.Results The differences between the test and control groups in SBP blood pressure decreases between T0 and T1,T2,and T3(△SBP)were statistically significant(P<0.001).There was no significant difference in the results of analysis of umbilical artery blood gases and Apgar scores between the two groups(P >0.05).The difference in severity of nausea and vomiting between the groups during the three time periods(T1,T2,T3)were statistically significant(P<0.001).Conclusions T1,T2,T3 are time periods during cesarean section in which there is a tendency for hypotension,nausea,vomiting,and other discomfort to occur.Ephedrine pretreatment may result in more

关 键 词：麻黄碱 布比卡因 剖宫产术 麻醉 脊椎 

分 类 号：R323.47[医药卫生—人体解剖和组织胚胎学] R719.8[医药卫生—基础医学]