静脉推注间羟胺治疗剖宫产术蛛网膜下腔麻醉后低血压的量效关系  

The dose-response relationship of intravenous metaraminol for treating hypotension after spinal anesthesia in cesarean section

作　　者：史洪枢 沈耀华 林素凤 王宏伟 Shi Hongshu

机构地区：[1]浙江中医药大学第二临床医学院,310053 [2]杭州市临平区妇幼保健院,310005 [3]浙江省立同德医院,310012

出　　处：《浙江临床医学》2024年第3期351-353,共3页Zhejiang Clinical Medical Journal

摘　　要：目的 探讨剖宫产术蛛网膜下腔麻醉后术中出现低血压单次静脉推注间羟胺的量效关系。方法 选取择期单胎妊娠,孕足月,年龄>18岁,ASA分级Ⅱ级,体质量指数≤35 kg/m^(2),蛛网膜下腔麻醉后出现低血压的剖宫产术产妇75例。按随机数字表分为5组,即静脉推注间羟胺0.2 mg、0.3 mg、0.4 mg、0.5 mg、0.6 mg不同剂量(D1组、D2组、D3组、D4组和D5组),每组各15例。术中记录产妇蛛网膜下腔麻醉后有无出现心动过缓、恶心呕吐、寒战,蛛网膜下腔麻醉后出现低血压时给予间羟胺后有无发生高血压,新生儿脐动脉血气,计算新生儿出生1 min、5 min Apgar评分等指标。采用Probit回归分析剖宫产术蛛网膜下腔麻醉后出现低血压单次静脉推注间羟胺的量效关系,分析半数有效剂量(ED_(50))、90%有效剂量(ED_(90))。结果 5组产妇静脉推注间羟胺后恶心呕吐发生率随间羟胺剂量的增加而降低,而高血压的发生率及治疗术中低血压的有效率随间羟胺剂量的增加而升高。单次静脉推注间羟胺治疗剖宫产术蛛网膜下腔麻醉后低血压的ED_(50)为0.37(95%CI:0.27~0.46)mg,ED_(90)为0.71(95%CI:0.58~1.15)mg。5组产妇新生儿脐动脉的p H值、PO_(2)、PCO_(2)、碱剩余及新生儿1 min Apgar评分、5 min Apgar评分组间差异均无统计学意义(P>0.05)。结论 单次静脉推注间羟胺治疗剖宫产术蛛网膜下腔麻醉后低血压的ED_(50)、ED_(90)分别为0.37 mg(95%CI:0.27~0.46)mg和0.71(95%CI:0.58~1.15)mg。Objective To investigate the dose-response relationship of intravenous metaraminol for the treatment of hypotension during spinal anesthesia in cesarean section.Methods A total of 75 parturients undergoing elective cesarean section with full-term singleton pregnancies,aged>18 years,American Society of Anesthesiologists(ASA)class II,body mass index(BMI)≤35 kg/m^(2),and experiencing hypotension after spinal anesthesia were selected.They were randomLy divided into five groups using a random number table,namely,different dosage groups of metaraminol bolus administration(D1 group,D2 group,D3 group,D4 group,and D5 group)with doses of 0.2,0.3,0.4,0.5,and 0.6 mg,respectively,with 15 cases in each group.Intraoperative records were kept to monitor the occurrence of bradycardia,nausea/vomiting,and shivering in the parturients after spinal anesthesia.The administration of metaraminol for hypotension following spinal anesthesia was observed for the occurrence of hypertension.Umbilical artery blood gas analysis was conducted on the newborns,and indicators such as 1-minute and 5-minute Apgar scores were calculated.Probit regression analysis was employed to analyze the dose-response relationship curve of metaraminol administered as a single bolus for the treatment of hypotension during cesarean section under spinal anesthesia.The median effective dose(ED_(50))and the 90%effective dose(ED_(90))were determined.Results The incidence of nausea and vomiting decreased with increasing doses of metaraminol administered via bolus injection in the five groups of parturients.However,the incidence of hypertension and the effective rate of treating intraoperative hypotension increased with higher doses of metaraminol.The ED_(50) of metaraminol administered as a single bolus for treating hypotension after spinal anesthesia during cesarean section was 0.37(95%CI:0.27~0.46)mg,and ED_(90) was 0.71(95%CI:0.58~1.15)mg.There were no statistically significant differences among the five groups of parturients in terms of umbilical artery pH,PO_(2),P

关 键 词：间羟胺 剖宫产 蛛网膜下腔麻醉 低血压 剂量量效关系 

分 类 号：R614[医药卫生—麻醉学]