小剂量盐酸甲氧明对剖宫产术中孕妇血流动力学及新生儿血气指标的影响  

Effect of low dose Methoxamine Hydrochloride on neonatal blood gas indexes and hemodynamics of pregnant women during cesarean section

作　　者：张海青 鲍永新 闫作丽 牛亮 ZHANG Hai-qing;BAO Yong-xin;YAN Zuo-li;NIU Liang(Department of Anesthesiology,Qingdao Women's and Children's Hospital,Shandong Qingdao 266034,China)

机构地区：[1]青岛市妇女儿童医院麻醉科,山东青岛266034

出　　处：《临床药物治疗杂志》2021年第4期39-43,共5页Clinical Medication Journal

摘　　要：目的探讨剖宫产术中应用小剂量盐酸甲氧明对孕妇血流动力学及新生儿血气指标的影响。方法2016年8月至2017年11月就诊于青岛市妇女儿童医院行剖宫产手术的孕妇共87例作为研究对象,采用随机数字表法将其分为观察组(44例)和对照组(43例),所有孕妇均行腰-硬联合麻醉,观察组在麻醉完成后即刻静脉注射1 mg盐酸甲氧明,对照组静脉注射2 mL生理盐水,比较不同时间两组孕妇麻醉前后收缩压(SBP)、舒张压(DBP)和心率(HR)变化情况,包括入室后基础值(T_(0))、麻醉后即刻(T_(1))、麻醉后1 min(T_(2))、麻醉后5 min(T3)、新生儿娩出前1 min(T_(4))及新生儿娩出后5 min(T_(5));新生儿出生后1 min使用Apgar评分评估其身体状态,同时比较新生儿脐静脉血pH值、血气指标氧分压(PO_(2))及二氧化碳分压(PCO_(2))水平。结果观察组T_(1)时刻HR明显低于T_(0),T_(4)时刻明显高于T_(0),差异均有统计学意义(均P<0.05),其他时间点与T_(0)比较差异均无统计学意义(均P>0.05);对照组T_(1)时刻HR明显低于T_(0),T_(2)~T_(5)时刻明显高于T_(0);观察组T_(2)~T_(5)时刻HR均明显低于对照组,差异均有统计学意义(均P<0.05)。观察组与对照组T_(1)~T_(4)时刻SBP和DBP均明显低于T_(0)时刻,且观察组T_(1)~T_(5)时刻SBP和DBP均明显高于对照组。观察组新生儿出生1 min后Apgar评分[(9.1±0.8)分]明显高于对照组[(8.0±0.8)分],观察组PO_(2)水平[(28±4)kPa]明显高于对照组[(25±3)kPa],观察组PCO_(2)水平[(46±6)kPa]明显低于对照组[(51±6)kPa],差异均有统计学意义(均P<0.05)。观察组孕妇术中不良反应发生率(13.64%)与对照组(11.63%)比较差异无统计学意义(P>0.05)。结论在剖宫产手术中,应用小剂量盐酸甲氧明能帮助孕妇和新生儿维持麻醉后血压、HR和血气指标水平,不良反应小,对提升剖宫产手术安全性有积极意义,该方案具有推广应用价值。Objective To explore the effect of low-dose Methoxamine Hydrochloride on neonatal blood gas indexes and hemodynamics of pregnant women during cesarean section.Methods A total of 87 pregnant women who underwent cesarean section in Qingdao Women’s and Children’s Hospital from August 2016 to November 2017 were as the research objects,and they were divided into observation group(44 cases)and control group(43 cases)by random number table method.All pregnant women underwent combined spinal-epidural anesthesia,the observation group received an intravenous injection of 1 mg Methoxamine Hydrochloride immediately after the anesthesia was completed,and the control group received an intravenous injection of 2 mL normal saline.Measurement and comparison of changes in systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)of the two groups of pregnant women before and after anesthesia,including basic value after entering the room(T_(0)),immediately after anesthesia(T_(1)),1 min after anesthesia(T_(2)),5 min after anesthesia(T3),1 min before the newborn is delivered(T_(4)),5 min after the newborn is delivered(T_(5)).The Apgar score was used to assess the physical state of the newborn 1 min after birth,simultaneously measure and compare the neonatal cord venous blood pH,blood gas index partial pressure of oxygen(PO_(2))and carbon dioxide(PCO_(2))levels.Results Compared with the results of HR measurement,the HR of observation group was significantly lower than T_(0)at T_(1)(P<0.05),and T_(4)was significantly higher than T_(0)(P<0.05),there was no significant difference compared with T_(0)at other time points(P>0.05);The HR at T_(1)of the control group was significantly lower than T_(0)(P<0.05),and the HR at T_(2)-T_(5)was significantly higher than T_(0)(P<0.05),and the HR at T_(2)-T_(5)of the observation group was significantly lower than that of the control group(P<0.05).Compared with SBP and DBP at different time points,the SBP and DBP at T_(1)-T_(4)of the observation group and the control group were si

关 键 词：盐酸甲氧明 剖宫产 血气指标 不良反应 

分 类 号：R614[医药卫生—麻醉学]