去甲肾上腺素预泵注对腰硬联合麻醉下剖宫产产妇血流动力学影响的临床观察  

Clinical observation of the effect of pre-pumping norepinephrine on hemodynamics of cesarean section parturients under combined spinal-epidural anesthesia

作　　者：陆松虹[1] 徐晖[1] 程亮[1] 鲍奎斌 刘倩影 张访 LU Song-hong;XU Hui;CHENG Liang;BAO Kui-bin;LIU Qian-ying;ZHANG Fang(Department of Anesthesiology,The Third People′s Hospital of Bengbu,Bengbu Anhui 233000,China)

机构地区：[1]安徽省蚌埠市第三人民医院麻醉科,233000

出　　处：《蚌埠医学院学报》2022年第11期1546-1549,1553,共5页Journal of Bengbu Medical College

摘　　要：目的:观察预泵注去甲肾上腺素对腰硬联合麻醉后剖宫产病人血流动力学的影响。方法:选择60例ASAⅠ~Ⅱ级、择期行腰硬联合麻醉后剖宫产病人,随机分为观察组和对照组,各30例。所有病人麻醉前30 min输注羟乙基淀粉10 mL/kg,腰硬联合麻醉穿刺开始时对照组病人持续泵注0.9%氯化钠溶液0.75 mL·kg^(-1)·h^(-1),观察组持续泵注去甲肾上腺素0.75 mL·kg^(-1)·h^(-1)(0.05μg·kg^(-1)·min^(-1)),直至胎儿娩出。比较2组入室时(T_(0))、扩容后(T_(1))、麻醉后1 min(T_(2))、麻醉后3 min(T_(3))、胎儿娩出时(T_(4))、术毕(T_(5))时的平均动脉压(MAP)、心率(HR),新生儿1 min、5 min Apgar评分及不良反应发生情况。结果:2组病人手术时间、麻醉操作时间及出血量差异均无统计学意义(P>0.05)。2组病人T_(0)时MAP、HR差异均无统计学意义(P>0.05);观察组T_(2)时MAP高于对照组(P<0.05),T_(2)、T_(3)时HR低于对照组(P<0.01和P<0.05);与T_(0)时比较,对照组病人MAP在麻醉后有所降低,但差异无统计学意义(P>0.05),T_(2)、T_(3)时HR增快(P<0.05);观察组病人各时点MAP和HR与T_(0)时差异均无统计学意义(P>0.05)。2组病人低血压、高血压、恶心呕吐和心动过缓发生率差异均无统计学意义(P>0.05)。2组新生儿1 min、5 min Apgar评分差异均无统计学意义(P>0.05)。结论:麻醉前预泵注去甲肾上腺素0.05μg·kg^(-1)·min^(-1),产妇血流动力学平稳,对新生儿无影响,能够提高剖宫产母婴安全。Objective:To observe the effect of pre-pumping norepinephrine on hemodynamics of cesarean section patients under combined spinal-epidural anesthesia.Methods:Sixty ASAⅠ-Ⅱpatients with elective cesarean section after combined spinal-epidural anesthesia were randomly divided into the observation group and control group,with 30 cases in each group.All patients were infused with mL/kg hydroxyethyl starch 30 min before anesthesia.At the beginning of combined spinal-epidural anesthesia,the patients in the control group were continuously pumped with 0.75 mL·kg^(-1)·h^(-1)of 0.9%sodium chloride solution,and the patients in the observation group were continuously pumped with 0.75 mL·kg^(-1)·h^(-1)(0.05μg·kg^(-1)·min^(-1))of noradrenaline until delivery of the fetus.The mean arterial pressure(MAP),heart rate(HR),1 min and 5 min Apgar score of neonate,and adverse reactions were compared between the two groups at the time of admission(T_(0)),after volume expansion(T_(1)),1 min after anesthesia(T_(2)),3 min after anesthesia(T_(3)),at the time of fetal delivery(T_(4)),and at the end of operation(T_(5)).Results:There was no significant difference in operation time,anesthesia time and bleeding volume between the two groups(P>0.05).There was no significant difference in MAP and HR between the two groups at T_(0)(P>0.05);the MAP in the observation group at T_(2)was higher than that in the control group(P<0.05),and the HR at T_(2)and T_(3)was lower than that in the control group(P<0.01 and P<0.05);compared with T_(0),the MAP in the control group decreased after anesthesia,but the difference was not statistically significant(P>0.05),and the HR increased at T_(2)and T_(3)(P<0.05);there was no significant difference in MAP and HR between each time point and T_(0)in the observation group(P>0.05).There was no significant difference in the incidence of hypotension,hypertension,nausea and vomiting,and bradycardia between the two groups(P>0.05).There was no significant difference in 1 min and 5 min Apgar score between the two gro

关 键 词：剖宫产 腰硬联合麻醉 去甲肾上腺素 预泵注 血流动力学 

分 类 号：R719.8[医药卫生—妇产科学]