预防性输注去甲肾上腺素对剖宫产产妇脑氧饱和度的影响  

Effect of prophylactic infusion of norepinephrine on cerebral oxygen saturation in parturients undergoing cesarean section

作　　者：崔晓娜 贾丽洁 徐韬[1,2] 孟琼 徐子锋 Cui Xiaona;Jia Lijie;Xu Tao;Meng Qiong;Xu Zifeng(Department of Anesthesiology,the International Peace Maternity and Child Health Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200030,China;Shanghai Key Laboratory of Embryo Original Diseases,Shanghai 200030,China)

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院麻醉科,上海200030 [2]上海市胚胎源性疾病重点实验室,上海200030

出　　处：《国际麻醉学与复苏杂志》2025年第1期42-47,共6页International Journal of Anesthesiology and Resuscitation

摘　　要：目的比较预防性输注去甲肾上腺素(NE)和去氧肾上腺素(PE)对蛛网膜下腔阻滞(SA)行择期剖宫产产妇额叶脑氧饱和度(ScO_(2))的影响,寻找维持ScO_(2)更稳定的血管加压素。方法纳入在SA下行择期剖宫产的产妇106例,根据给药种类的不同,将入选者按随机数字表法分为两组:PE组(P组,52例)和NE组(N组,54例)。在蛛网膜下腔给药的同时启动输注泵,两组分别以PE 50μg/min和NE 4μg/min的固定速率输注30 min。记录两组产妇的一般资料(年龄、身高、体重和体重指数)。记录两组产妇ScO_(2)、收缩压、心率基础值,并计算从蛛网膜下腔给药至胎儿取出1、3、5 min时ScO_(2)下降幅度≥15%的比例。记录两组产妇术中低血压、心动过缓、恶心呕吐、头晕的发生率,以及补救血管活性药物(麻黄碱和阿托品)的使用率。记录两组产妇蛛网膜下腔给药至切皮时间、切皮至胎儿取出时间,以及新生儿取出后1、5 min时的Apgar评分。结果两组产妇一般资料差异均无统计学意义(均P>0.05)。两组产妇收缩压、心率和ScO_(2)基础值差异均无统计学意义(均P>0.05)。从蛛网膜下腔给药至胎儿取出:两组产妇在1 min的ScO_(2)下降幅度≥15%的比例差异无统计学意义(P>0.05);N组产妇在3、5 min时ScO_(2)下降幅度≥15%的比例均低于P组,差异有统计学意义(均P<0.05)。两组产妇低血压的发生率和麻黄碱的使用率差异均无统计学意义(均P>0.05);N组产妇头晕、恶心呕吐、心动过缓的发生率及阿托品的使用率均低于P组,差异有统计学意义(均P<0.05)。两组产妇蛛网膜下腔给药至切皮时间、切皮至胎儿取出时间,以及新生儿取出后1、5 min时Apgar评分,差异均无统计学意义(均P>0.05)。结论NE和PE在预防和治疗产妇SA后低血压方面效果相似,但NE更有利于维持术中心率和ScO_(2)的稳定。应用NE后产妇术中头晕、恶心呕吐的发生率和术中阿托品的使用率降低�Objective To compare the effect of prophylactic infusion of norepinephrine(NE)and phenylephrine(PE)on cere⁃bral oxygen saturation(ScO_(2))in the frontal lobe of parturients undergoing elective cesarean section under subarachnoid anaesthesia(SA),in order to identify a vasopressor that maintains ScO_(2) more stable.Methods A total of 106 parturients who underwent elective cesarean section under SA were included.According to the type of medication used,these participants were divided into two groups based on the random number table method:a PE group(group P,n=52)and an NE group(group N,n=54).An infusion pump was initiat⁃ed simultaneously with subarachnoid administration.Both groups were infused over 30 min with PE at 50μg/min and NE at 4μg/min,respectively.Their general data(age,height,body weight,and body mass index)were recorded.The baseline values of ScO_(2),systolic blood pressure and heart rate were recorded,while the percentages of parturients in each group experiencing a decrease in ScO_(2) of≥15%at 1,3 min and 5 min after subarachnoid administration until fetal extraction were calculated.The incidences of intraoperative hy⁃potension,bradycardia,nausea and vomiting,and dizziness,as well as the usage of rescue vasopressors(ephedrine and atropine)were recorded.Moreover,the time from subarachnoid administration to skin incision,the time rom skin incision to fetal extraction,and Ap⁃gar scores at 1 min and 5 min after neonatal extraction were documented.Results There were no statistical differences in general in⁃formation between the two groups (all P>0.05). There were no statistical differences in the baseline values of systolic blood pressure,heart rate, and ScO_(2) between the two groups (all P>0.05). From subarachnoid administration to fetal extraction, no statistical differenceswere see in the percentage of parturients with ScO_(2) decreases of ≥15% at 1 min between the two groups (P>0.05), and group N showedsignificant lower percentages of parturients with ScO_(2) decreases of ≥15% at 3 min

关 键 词：剖宫产 蛛网膜下腔阻滞 脑氧饱和度 去氧肾上腺素 去甲肾上腺素 

分 类 号：R614[医药卫生—麻醉学]