低血压高危产妇预注去氧肾上腺素对剖宫产腰硬联合麻醉后稳定血流效果  

Effect of the postoperative hemodynamic stability of the prophylactic phenylephrine infusion for treating high-risk women with hypotension during the combined spinal-epidural anesthesia

作　　者：唐旺 朱春义 王凡 刘苏 王光磊 TANG Wang;ZHU Chunyi;WANG Fan;LIU Su;WANG Guanglei(College of Anesthesiology,Xuzhou Medical University,Xuzhou,Jiangsu Province,221000;The Affiliated Hospital of Xuzhou Medical University,Xuzhou)

机构地区：[1]徐州医科大学麻醉学院,221000 [2]徐州医科大学附属医院

出　　处：《中国计划生育学杂志》2023年第10期2359-2365,共7页Chinese Journal of Family Planning

基　　金：江苏省高等学校基础科学(自然科学)研究重大项目(22KJA320007)。

摘　　要：目的:探究预防性输注去氧肾上腺素对低血压高危产妇血流动力学稳定性的影响。方法:选取2022年6-9月在本院择期腰硬联合麻醉下行剖宫产的低血压高危因素产妇80例,均灌注指数(PI)>3.5,随机数字表法分为预防性输注组和对照组各40例,输注组麻醉开始时接受0.5μg/kg/min预防性输注去氧肾上腺素,对照组输注等量生理盐水。两组均通过间断推注去氧肾上腺素将收缩压维持在基线≤20%。比较两组术中血流动力学指标、低血压发生率、不良事件发生率及新生儿结局。结果:输注组低血压(32.5%)、头晕/胸闷发生率(5%)、脐静脉二氧化碳分压(43.20mmHg)均低于对照组(85%、25%、45.50mmHg),脐静脉氧分压(30.15mmHg)高于对照组(25.40mmHg)(均P<0.05);两组心动过缓、反应性高血压及恶心/呕吐发生率无差异(P>0.05)。与基线血压相比,麻醉诱导后两组血压均降低,输注组术中血压值在基线血压值±10%范围内的累计时长(39.87±17.70min)高于对照组(27.79±15.32min),新生儿出生后输注组有更高的PaO_(2)、更低的PaCO_(2)和乳酸水平(均P<0.05)。结论:剖宫产术预防性输注去氧肾上腺素在腰硬联合麻醉后对低血压高危产妇可更好地稳定血流动力学,新生儿酸碱状态更佳。Objective:To explore the effect of the postoperative hemodynamic stability of the prophylactic phenylephrine infusion for treating high-risk women with hypotension during the combined spinal-epidural anesthesia.Methods:80 women who wanted elective cesarean section under combined spinal-epidural anesthesiain were selected in this study from June to September 2022.The perfusion index(PI) of these women was 3.5.These women were divided in two group s(40 cases in each group) by random number table method.The women in the study group were given prophylactic phenylephrine infusion(0.5μg/kg/min) at anesthesia induction,and the women in the control group were given infusion of the same amount of normal saline.The blood pressure of the women in the two groups was maintained within 20% of baseline values by intermittent phenylephrine administration.The intraoperative hemodynamic indicators,the incidences of hypotension and adverse events,and the neonatal outcomes of the women were compared between the two groups.Results:The incidences of hypotension(32.5%) and dizziness/chest tightness(5%),and the value of partial carbon dioxide pressure of umbilical vein(43.20mmHg) of the women in the study group were significantly lower than those(85%,25%,and 45.50mmHg) of the women in the control group,and the value of partial oxygen pressure of umbilical vein(30.15mmHg) of the women in the study group was significantly higher than that(25.40mmHg) of the women in the control group(all P<0.05).There were no significant differences in the incidences of bradycardia,reactive hypertension,and nausea/vomiting of the women between two groups(P>0.05).Compared with the value of baseline blood pressure,the value of blood pressure of the women in both groups after anesthesia induction had decreased significantly.The cumulative duration(39.87±17.70min)of the intraoperative blood pressure value within the range of baseline blood pressure±10%of the women in the study group was significantly higher than that(27.79±15.32min)of the women in the cont

关 键 词：剖宫产 高危低血压 腰硬联合麻醉 去氧肾上腺素 预防性用药 血流动力学 新生儿 

分 类 号：R614[医药卫生—麻醉学]