雷莫司琼与昂丹司琼预防剖宫产蛛网膜下腔阻滞后产妇低血压的临床观察  

Clinical observations of ramosetron and ondansetron in preventing maternal hypotension after subarachnoid block in cesarean section

作　　者：李福源 邹丽明 李小婷 陈文华[1] LI Fuyuan;ZOU Liming;LI Xiaoting;CHEN Wenhua(Department of Anesthesiology,Fujian Medical University Union Hospital,Fujian,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院麻醉科,福建福州350001

出　　处：《中国医药科学》2022年第21期163-167,共5页China Medicine And Pharmacy

摘　　要：目的观察术前应用5-羟色胺3(5-HT_(3))受体拮抗剂对剖宫产蛛网膜下腔阻滞后产妇低血压的影响。进一步研究在预防剖宫产蛛网膜下腔阻滞后低血压或减轻其低血压的程度上,雷莫司琼是否优于昂丹司琼。方法于2017年9月至2018年1月在福建医科大学附属协和医院选取105例择期行剖宫产手术的产妇,采用随机数表法分为A组(昂丹司琼4 mg)、L组(雷莫司琼0.3 mg+生理盐水48 ml)和S组(生理盐水50 ml)三组,每组各35例。三组患者均于麻醉前静脉滴注试验药物并在静脉滴注结束后进行蛛网膜下腔阻滞。比较分析蛛网膜下腔阻滞后25 min内的血压(BP)、心率(HR)、血氧饱和度(SpO_(2))变化,比较术中和术后寒战、恶心及呕吐的发生例数,比较术中最高麻醉平面、新生儿1 min和5 min Apgar评分。结果T_(2~7)时间点与T_(0)比较,L组SBP下降幅度小于A组和S组;T_(2~3)时间点与T_(0)比较,A组SBP下降幅度小于S组;T_(3~4)时间点与T_(0)比较,L组MAP下降幅度小于A组和S组;T_(2)时间点与T_(0)比较,A组MAP下降幅度小于S组;L组和A组低血压的发生率均低于S组,差异均有统计学意义(P<0.0167)。结论术前预给予5-HT_(3)受体拮抗剂可降低择期产科蛛网膜下腔阻滞后低血压的发生率。在减轻蛛网膜下腔阻滞后SBP和MAP的降低程度上,雷莫司琼比昂丹司琼更有效。Objective To observe the effect of preoperative application of 5-hydroxytryptamine 3(5-HT_(3))receptor antagonist on maternal hypotension after subarachnoid block in cesarean section and to explore whether ramosetron is more effective than ondansetron in preventing or reducing the degree of hypotension after subarachnoid block in cesarean section.Methods A total of 105 patients who underwent elective cesarean section in Fujian Medical University Union Hospital from September 2017 to January 2018 were randomly divided into Group A(ondansetron 4 mg),Group L(ramosetron 0.3 mg+normal saline 48 ml)and Group S(normal saline 50 ml),with 35 patients in each group.All patients in the three groups received intravenous drip of the investigational drug before anesthesia and then received subarachnoid block.The following aspects were compared and analyzed:the changes of blood pressure(BP),heart rate(HR)and pulse oxygen saturation(SpO_(2))within 25 minutes after subarachnoid block,the incidences of shivering、nausea and vomiting occurred intraoperatively and postoperatively,as well as the highest intraoperative anesthesia block level,1 min and 5 min Apgar scores in neonates.Results Compared with T_(0),systolic blood pressure(SBP)decreased less in Group L than in Group A and Group S at T2-7 time point,and Group A decreased less than Group S at T_(2-3) time point.Compared with T_(0),mean arterial pressure(MAP)decreased less in Group L than in Group A and Group S at T_(3-4) time point,and Group A decreased less than Group S at T_(2) time point.The probability of hypotension in Group L and Group A were lower than that in Group S,with statistically significant differences(P<0.0167).Conclusion Preoperative administration of 5-HT_(3) receptor antagonist can reduce the incidence of hypotension after selective obstetric subarachnoid block.Ramosetron is more effective than ondansetron in reducing the reduction of SBP and MAP after subarachnoid block.

关 键 词：雷莫司琼 昂丹司琼 蛛网膜下腔阻滞 剖宫产 低血压 

分 类 号：R614[医药卫生—麻醉学]