去甲肾上腺素和麻黄碱治疗子痫前期产妇腰麻后低血压效果的比较  

Comparison of efficacy of norepinephrine and ephedrine for the treatment of spinal hypotension in preeclamptic parturients

作　　者：钱锐锋[1] 王朝辉[1] 毛毛[1] 徐世琴[1] 沈晓凤[1] 王娴[1] QIAN Ruifeng;WANG Zhaohui;MAO Mao;XU Shiqin;SHEN Xiaofeng;WANG Xian(Department of Anesthesiology,Women's Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Nanjing 210004,China)

机构地区：[1]南京医科大学附属妇产医院,南京市妇幼保健院麻醉科,210004

出　　处：《临床麻醉学杂志》2020年第12期1191-1194,共4页Journal of Clinical Anesthesiology

摘　　要：目的比较等效去甲肾上腺素和麻黄碱用于治疗子痫前期产妇剖宫产腰麻后低血压的效果。方法选择腰麻后出现低血压的子痫前期产妇111例,年龄22~36岁,BMI≤35 kg/m^2,ASAⅡ级,随机分为去甲肾上腺素组(N组,n=56)和麻黄碱组(E组,n=55),分别在出现低血压(SBP<基础值80%)后静脉注射去甲肾上腺素4μg或麻黄碱4 mg。观察产妇入室时、腰麻后1、3、5、10 min、胎儿娩出时HR和SBP。记录腰麻完成至胎儿娩出期间产妇心动过速(HR>120次/分)、心动过缓(HR<60次/分)和高血压(SBP>基础值120%)的发生情况;以及使用血管活性药的次数和不良反应,包括恶心、呕吐、眩晕和寒战。记录新生儿Apgar评分和脐动脉血气分析。结果与E组比较,N组腰麻后3、5、10 min及胎儿娩出时产妇HR明显减慢(P<0.05),心动过速发生率明显降低(P<0.05),新生儿脐动脉血pH、HCO-3和BE明显升高(P<0.05),乳酸(Lac)明显降低(P<0.05)。两组产妇心动过缓和高血压的发生率、使用血管活性药的次数、眩晕和寒战的发生率差异无统计学意义。两组新生儿Apgar评分、脐动脉血PaO 2、PaCO 2、Glu差异无统计学意义。结论等效去甲肾上腺素与麻黄碱治疗子痫前期产妇腰麻后低血压的效果相似,但去甲肾上腺素的安全性更高。Objective To explore the efficacy of equivalent norepinephrine and ephedrine for the treatment of spinal hypotension in preeclamptic parturients during cesarean delivery.Methods In this randomized double-blind controlled study,111 preeclamptic spinal hypotension parturients,aged 22-36 years,BMI≤35 kg/m^2,ASA physical statusⅡ,were randomly assigned to receive intravenous infusion norepinephrine 4μg(group N,n=56)or ephedrine 4 mg(group E,n=55)when hypotension occurred(SBP<80%baseline).Maternal HR and SBP at the time-point of entering the operating room,1,3,5,10 minutes after spinal anesthesia and fetal delivery were observed.Incidences of tachycardia(HR>120 beats/min),bradycardia(HR<60 beats/min),hypertension(SBP>120%baseline),number of vasopressor boluses,maternal side effects such as nausea,vomiting,dizziness and shivering at the period from the completion of spinal anesthesia to the delivery of the fetus were observed.Neonatal outcomes including Apgar score and umbilical arterial blood gas were observed.Results Maternal HR at the time-point of 3,5,10 min after spinal anesthesia and fetal delivery in group N was lower than those in group E(P<0.05),and the incidence of tachycardia,nausea and vomiting in group N were also lower than those of group E(P<0.05);pH,HCO-3 and BE of umbilical artery for neonates in group N were higher than those of group E(P<0.05),while Lac of umbilical artery for infants in group N was lower than those of group E(P<0.05).There were no significant differences in maternal SBP,the incidence of bradycardia and hypertension,the number of vasopressor boluses,the incidence of dizziness,and shivering between the two groups.There were no significant differences in neonatal Apgar score,pH,PaO 2,PaCO 2,and Glu between the two groups.Conclusion An equipotent bolus of norepinephrine and ephedrine for the treatment of spinal hypotension shows a similar efficacy in preeclamptic parturients,while presents a better maternal and neonatal safety compared to ephedrine in preeclamptic parturients.

关 键 词：去甲肾上腺素 麻黄碱 子痫前期 腰麻后低血压 

分 类 号：R614[医药卫生—麻醉学]