可变速率与固定速率静脉持续输注去甲肾上腺素预防剖宫产蛛网膜下腔麻醉后低血压比较  

作　　者：吴战怀 周蓉[2] 

机构地区：[1]杭州市丁桥医院,310000 [2]杭州市中医院,310009

出　　处：《浙江临床医学》2023年第7期1067-1069,共3页Zhejiang Clinical Medical Journal

摘　　要：目的比较可变速率和固定速率静脉持续输注去甲肾上腺素预防产妇剖宫产蛛网膜下腔麻醉后低血压的效果。方法选择2019年3月至2020年11月择期剖宫产产妇160例,按随机数字表法分成F组(固定速率组)和V组(可变速率组),每组各80例。产妇于L3~4间隙行蛛网膜下腔麻醉穿刺,在鞘内注射的同时,F组即刻静脉给予5µg去甲肾上腺素,随后用微泵以0.05µg/(kg·min)的速率开始输注去甲肾上腺素,当收缩压<80%基线值时,静脉推注去甲肾上腺素5µg或10µg;V组同样以0.05µg/(kg·min)速率开始输注去甲肾上腺素,随后根据收缩压变化在0~0.14µg/(kg·min)的范围内手动调节去甲肾上腺素的输注速率,使其接近基线水平。观察两组产妇蛛网膜下腔麻醉后低血压的发生率、前15 min血流动力学变化、医师的干预次数、反应性高血压的发生率、恶心和呕吐、心动过缓、去甲肾上腺素使用剂量及新生儿的结局。结果F组和V组蛛网膜下腔麻醉后低血压发生率差异无统计学意义(P>0.05)。V组医师干预次数高于F组(P<0.001)。二组产妇前15min收缩压和心率连续变化、反应性高血压、恶心呕吐和心动过缓发生率差异均无统计学意义(P>0.05)。两组间去甲肾上腺素使用剂量差异有统计学意义(P<0.05)。两组新生儿结局差异均无统计学意义(P>0.05)。结论可变速率和固定速率静脉持续输注去甲肾上腺素均能有效预防剖宫产蛛网膜下腔麻醉后低血压发生率,由于可变速率方案需要频繁的医师干预。推荐在临床实践中采用固定速率方案。Objective To compare the effect of variable-rate and fixed-rate infusion of norepinephrine for preventing hypotension during spinal anesthesia for cesarean delivery.Methods A total of 160 cases of parturient eligible for elective delivery from March 2019 to November 2020 were enrolled in the study.Parturients were randomly assigned to the group F(fixed-rate group)and the group V(variable-rate group)according to random number table method,with 80 cases in each group.15 mg of hyperbaric ropivacaine(3 mL)was injected at the L3~4 space for spinal anesthesia.Concurrent with the intrathecal injection.In group F,a bolus of 5μg norepinephrine was given immediately,and then norepinephrine was initiated at the rate of 0.05μg/(kg·min)using a syringe pump.A bolus of norepinephrine 5μg or 10μg was given when SBP decreased to<80%of baseline.In the group V,norepinephrine was initiated at the rate of 0.05μg/(kg·min)using a syringe pump,and then manually adjusted the infusion rate of norepinephrine in the range of 0~0.14μg/(kg·min)according to the change of SBP to maintain values close to the baseline.During the study period,the incidence of maternal hypotension,hemodynamic changes in the first 15 minutes,the number of physician interventions,reactive hypertension,nausea and vomiting,bradycardia,norepinephrine cumulative dose,and neonatal outcomes were recorded.Results There was no significant difference in the incidence of hypotension after spinal anesthesia between the two groups(P>0.05).The number of physician interventions in the group V was significantly higher than that in the group F(P<0.001).No significant difference was found in the serial changes in SBP and HR for the first 15 minutes,the incidence of reactive hypertension,nausea and vomiting and bradycardia among the two groups(all P>0.05).The norepinephrine cumulative dose was significantly different between the two groups(P<0.05).No significant differences were found in the neonatal outcomes between the both groups(P>0.05).Conclusion Both variable-rate and f

关 键 词：去甲肾上腺素 变速速率 低血压 剖宫产 

分 类 号：R614[医药卫生—麻醉学]