不同剂量复方氯化钠注射液联合去甲肾上腺素预防剖宫产术患者腰麻后低血压的效果  

Effect of different doses of compound sodium chloride injection combined with norepinephrine on prevention of hypotension after lumbar anesthesia in patients undergoing caesarean section

作　　者：朱园 陈易[2] 秦蕊[2] 郭蕾 薛伟[3] 何玲[3] 马淑琴[3] 倪新莉[2] Zhu Yuan;Chen Yi;Qin Rui;Guo Lei;Xue Wei;He Ling;Ma Shuqin;Ni Xinli(Anesthesiology,Ningxia Medical University,Yinchuan 750004,China;Department of Anesthesiology and Perioperative Medicine,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Obstetrics,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学临床医学院,银川750004 [2]宁夏医科大学总医院麻醉与围术期医学科,银川750004 [3]宁夏医科大学总医院产科,银川750004

出　　处：《中华麻醉学杂志》2023年第3期278-282,共5页Chinese Journal of Anesthesiology

基　　金：宁夏回族自治区重点研发项目(2021BEG03039)。

摘　　要：目的评价不同剂量复方氯化钠注射液联合去甲肾上腺素预防剖宫产术患者腰麻后低血压的效果。方法选择拟在腰麻下行剖宫产术患者150例,年龄18~45岁,单胎妊娠,孕周≥37周,ASA分级Ⅰ或Ⅱ级,身高≥150 cm,体质量≤100 kg,BMI<40 kg/m^(2)。采用随机数字表法分为3组(n=50):复方氯化钠注射液4、8、12 ml·kg^(-1)·h^(-1)组(A组、B组、C组)。腰麻前静脉输注复方氯化钠注射液4 ml/kg进行液体预充,蛛网膜下腔注射0.5%重比重布比卡因12.5 mg进行腰麻。蛛网膜下腔给药即刻静脉注射去甲肾上腺素6μg,然后以0.05μg·kg^(-1)·min^(-1)的速率静脉泵注,至胎儿娩出后5 min停药;同时A组、B组和C组分别静脉输注复方氯化钠注射液4、8、12 ml·kg^(-1)·h^(-1)。分别于液体预充前1 min(T_(1))、液体预充后即刻(T_(2))、麻醉后5 min(T_(3))、胎儿娩出后5 min(T_(4))及出室前即刻(T_(5)),采用超声测量下腔静脉直径最大值(IVCmax)和下腔静脉直径最小值(IVCmin),计算下腔静脉坍塌指数(IVC-CI)。记录患者术中不良事件(低血压、严重低血压、心动过缓、高血压、恶心、呕吐)发生情况和新生儿转归各指标(脐动脉血气指标和出生1、5 min的Apgar评分)。结果与A组比较,B组T_(5)时IVCmin增加,IVC-CI降低,C组T_(5)时IVCmin和IVCmax增加,IVC-CI降低(P<0.05);B组和C组各时点IVCmax、IVCmin和IVC-CI比较差异无统计学意义(P>0.05)。3组间低血压、严重低血压、窦性心动过缓、高血压、恶心和呕吐发生率比较差异无统计学意义(P>0.05)。3组新生儿脐动脉血气分析结果和出生后各时点Apgar评分比较差异无统计学意义(P>0.05)。结论复方氯化钠注射液4、8、12 ml·kg^(-1)·h^(-1)联合去甲肾上腺素均能有效预防剖宫产术患者腰麻后低血压发生,且不增加母婴不良事件,8、12 ml·kg^(-1)·h^(-1)容量补充的效果优于4 ml·kg^(-1)·h^(-1)。Objective To evaluate the effect of different doses of compound sodium chloride injection combined with norepinephrine on prevention of hypotension after lumbar anesthesia in the patients undergoing caesarean section.Methods A total of 150 patients with a singleton fetus,aged 18-45 yr,at≥37 weeks of gestation,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,with height≥150 cm,weighing≤100 kg,with body mass index<40 kg/m^(2),scheduled for elective caesarean section under lumbar anesthesia,were divided into 3 groups(n=50 each)by the random number table method:compound sodium chloride injection 4,8 and 12 ml·kg^(-1)·h^(-1) groups(group A,group B,group C).Compound sodium chloride injection 4 ml/kg was intravenously injected for liquid preload before lumbar anesthesia,and 0.5%hyperbaric bupivacaine 12.5 mg was injected to the subarachnoid space for lumbar anesthesia.Norepinephrine was intravenously injected at a dose of 6μg immediately after intrathecal injection,followed by an infusion of 0.05μg·kg^(-1)·min^(-1),and infusion was stopped at 5 min after delivery.Compound sodium chloride injection was intravenously infused simultaneously at a rate of 4,8 and 12 ml·kg^(-1)·h^(-1) in A,B and C groups,respectively.The maximum diameter of inferior vena cava(IVCmax)and the minimum diameter of inferior vena cava(IVCmin)were measured by ultrasound,and inferior vena cava collapse index(IVC-CI)was calculated at 1 min before fluid preload(T_(1)),immediately after fluid preload(T_(2)),at 5 min after anesthesia(T_(3)),at 5 min after fetal delivery(T_(4))and immediately before leaving the operating room(T_(5)).The incidence of intraoperative adverse events(hypotension,severe hypotension,bradycardia,hypertension,nausea,and vomiting)and neonatal outcomes(umbilical artery blood gas index and Apgar score at 1 and 5 min after birth)were recorded.Results Compared with group A,IVCmin was significantly increased and IVC-CI was decreased at T_(5) in group B,and IVCmin and IVCmax were significantly

关 键 词：氯化钠 去甲肾上腺素 麻醉 脊椎 低血压 剖宫产 

分 类 号：R614[医药卫生—麻醉学]