去氧肾上腺素与麻黄碱个体化剂量泵注对腰硬联合剖宫产产妇及新生儿的影响  

Clinical Effect of Phenylephrine and Ephedrine Individualized Dose Pump in Patients Under Cesarean Section with Combined Spinal and Epidural Anesthesia

作　　者：徐妍婷 巫绍汝 XU Yan-ting;WU Shao-ru(Department of Gynaecology,First Afiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China;Department of Anesthesiology,First Afiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China)

机构地区：[1]苏州大学附属第一医院妇产科,江苏苏州215006 [2]苏州大学附属第一医院麻醉科,江苏苏州215006

出　　处：《中国血液流变学杂志》2019年第4期476-479,共4页Chinese Journal of Hemorheology

摘　　要：目的探讨去氧肾上腺素与麻黄碱同等效价前提下个体化剂量泵注用于腰硬联合剖宫产术对于产妇心率血压、不良反应的发生以及新生儿Apgar评分、脐动脉血气结果、心率等指标的影响.方法选择2018年10月-2019年9月择期腰硬联合麻醉下行剖宫产术患者80例,采用随机数字表法分为两组:去氧肾上腺素组(A组,n=40)与麻黄碱组(B组,n=40),顺利完成腰硬联合麻醉操作并恢复平卧位后,A组泵注去氧肾上腺素0.5μg·kg^-1·min^-1,B组泵注麻黄碱40μg·kg^-1·min^-1,直至胎儿娩出时停止泵注,同时记录产妇术前(T1)、给药后1 min(T2)、3 min(T3)、5 min(T4)、胎儿娩出时(T5)的平均动脉压与心率数值,记录产妇给药后至手术结束期间不良反应(恶心呕吐、高血压、低血压、心动过速、心动过缓、头晕)的发生,新生儿1 min、5 min Apgar评分、1 min时心率值与脐动脉血气分析结果.结果A组患者在T2、T3、T4、T5时间点的心率组间比较明显低于B组(P<0.05),B组恶心呕吐、心动过速的发生率均明显多于A组(P<0.05),A组产妇的新生儿娩出后1 min时的心率明显低于B组(P<0.05),脐动脉血气分析pH、PCO2、BE、乳酸等指标方面两组差异均有统计学意义(P<0.05).结论去氧肾上腺素个体化剂量泵注给药,相比麻黄碱更有利于改善腰硬联合剖宫产术中出现的低血压,减少产妇恶心呕吐、心动过速的发生,对新生儿内环境稳态影响小,更适合用于产科麻醉.Objective To evaluate the clinical efect of phenylephrine and ephedrine individualized dose pump on maternal heart rate,blood pressure,adverse reactions,neonatal Apgar score,umbilical arterial blood gas results,heart rate in patients under cesarean section with combined spinal and epidural anesthesia.Methods Eighty patients undergoing cesarean section with combined spinal and epidural anesthesia were randomly divided into group phenylephrine(group A,n=40)and group ephedrine(group B,n=40).Group A was pumped with phenylephrine 0.5μg·kg^-1min^-1,and group B was pumped with ephedrine 40μg·kg^-1min^-1 until the baby is delivered after completing the combined spinal and anesthesia operation and restore supine position.At the same time,the MAP and HR values of preoperative(T1),1 min(T2),3 min(T3),5 min(T4)after administration,and fetal delivery(T5)were recorded.Adverse reactions include nausea and vomiting,hypertension,hypotension,tachycardia,bradycardia,dizziness were recorded until the end of operation.Also neonatal Apgar score at 1 min,5 min after childbirth,HR at 1 min after childbirth and umbilical arterial blood gas analysis results were recorded.Results The HR in group A at the T2,T3,T4,and T5 was significantly lower than group B(P<0.05).The incidence of nausea and vomiting,tachycardia in group B were significantly higher than group A(P<0.05)..The HR at 1 min after delivery in group A was significantly lower than group B(P<0.05).Umbilical arterial blood gas analysis showed significant differences in pH,PCO2,BE,lactate(P<0.05).Conclusion Individualized dose pumping of phenylephrine is more effective than ephedrine in improving hypotension for patients under cesarean section with combined spinal and epidural anesthesia,reducing the incidence of nausea and vomiting and tachycardia,more conducive to maintaining the balance of the intermal environment and more suitable for obstetric anesthesia.

关 键 词：去氧肾上腺素 麻黄碱 腰硬联合 剖宫产 

分 类 号：R614[医药卫生—麻醉学] R719[医药卫生—外科学]