麻黄碱和去氧肾上腺素对子痫前期产妇腰麻后低血压作用的比较  

Comparison of the effects of ephedrine and phenylephrine on hypotension after spinal anesthesia in preeclampsia parturient women

作　　者：李仁奇 袁红梅[1] 冯善武[1] 王娴[1] LI Ren-qi;YUAN Hong-mei;FENG Shan-wu(Department of Anesthesiology,Women's Hospital of Nanjing Medical University(Nanjing Maternity and Child Health care Hospital),Nanjing Jiangsu 210000,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,江苏南京210000

出　　处：《临床和实验医学杂志》2022年第18期2013-2016,F0003,共5页Journal of Clinical and Experimental Medicine

基　　金：江苏省社会发展面上项目(编号:BE2021615)。

摘　　要：目的比较等效剂量麻黄碱和去氧肾上腺素对子痫前期产妇剖宫产腰麻后低血压治疗的效果。方法本研究回顾性纳入2018年1~12月南京医科大学附属妇产医院收治的子痫前期产妇腰麻后低血压者117例,并根据麻醉方法不同将其分为去氧肾上腺素组(P组,n=59)和麻黄碱组(E组,n=58),在出现低血压(收缩压<基础值的80%)后分别静脉注射50μg去氧肾上腺素和4 mg麻黄碱。记录产妇入室后麻醉前平静状态下基础值、静注血管活性药物即刻(0时间点)及之后10 min的生命体征、麻醉后直至胎儿娩出时间段产妇窦性心动过速、窦性心动过缓和高血压的次数、血管活性药物使用剂量及次数、母体的不良反应。记录新生儿1 min和5 min Apgar评分及脐动脉血气分析结果。结果与基础值相比,P组产妇首剂去氧肾上腺素后8、9 min时间点的心率显著降低,E组产妇首剂麻黄碱后2、3、4 min时间点的心率显著增快,差异均有统计学意义(P<0.05);E组首剂麻黄碱后1、2、3、4、6、8、9 min时间点的心率显著快于P组相应时间点,差异均有统计学意义(P<0.05)。P组和E组首剂血管活性药物即刻及之后1、2、3、4、5、6、7、8、9、10 min收缩压显著低于基础值,差异均有统计学意义(P<0.05)。E组标准化心率显著快于P组,心动过速发生率显著高于P组,心动过缓发生率显著低于P组,差异均有统计学意义(P<0.05)。两组产妇恶心、呕吐、眩晕、寒战的发生率比较,差异均无统计学意义(P>0.05)。两组新生儿Apgar评分比较,差异无统计学意义(P>0.05)。E组脐动脉血气p H值显著低于P组,Pa O2、BE负值以及血乳酸显著高于P组,差异均有统计学意义(P<0.05)。结论等效麻黄碱与去氧肾上腺素治疗子痫前期产妇腰麻后低血压的药效相似,但去氧肾上腺素治疗可降低母体心率,利于心脏氧供需平衡,临床使用更安全有效。Objective To compare the effects of equivalent dose of ephedrine and phenylephrine in the treatment of hypotension in preeclampsia women after spinal anesthesia of cesarean section.Methods This study retrospectively included 117 preeclamptic women with hypotension after spinal anesthesia admitted to Women's Hospital of Nanjing Medical University from January to December 2018,and divided them into phenylephrine group(group P,n=59)and ephedrine group(group E,n=58)according to different anesthesia methods.After hypotension(SBP<80%of baseline),50μg of phenylephrine or 4 mg of ephedrine were administered intravenously.Vital signs of baseline(before anesthesia)and time point at the first intravenous injections of vasoactive drugs and 10 minutes after these injections,times of sinus tachycardia,sinus bradycardia,hypertension,dosage and frequency of vasoactive drugs and maternal adverse reactions after anesthesia were recorded.The Apgar score and umbilical artery blood gas analysis were recorded at 1 and 5 minutes.Results Compared with the baseline value,HR of group P decreased significantly at 8 and 9 minutes after the first intravenous injections of phenylephrine,while that of group E increased significantly at 2,3 and 4 minutes after the first intravenous injections of ephedrine,and the differences were statistically significant(P<0.05);and HR of group E at 1,2,3,4,6,8 and 9 minutes after the first intravenous injections of ephedrine were significantly faster than that of group P respectively,and the differences were statistically significant(P<0.05).SBP of group P and E were significantly lower than baseline levels at time point of the first intravenous injections of vasoactive drugs and 1,2,3,4,5,6,7,8,9 and 10 minutes after injections,and the differences were statistically significant(P<0.05).The standardized HR in group E was significantly faster than that of group P,and the incidence of tachycardia in group E was significantly higher than that of group P,while the incidence of bradycardia in group E was signific

关 键 词：子痫前期 腰麻 麻黄碱 去氧肾上腺素 低血压 

分 类 号：R614[医药卫生—麻醉学]