目的 研究硬膜外麻醉下剖宫产产妇应用小剂量去氧肾上腺素对产妇容量的影响.方法 选取2014年1月~2015年1月石家庄市第四医院生产时出现低血压的60例ASAⅠ~Ⅱ级足月妊娠产妇为研究对象,将所有患者按照随机数字表法分为对照组和研究组,每组各30例.对照组产妇在发生低血压时给予6 mg盐酸麻黄碱注射液至手术结束,研究组产妇在血压连续两次测得下降时给予研究组产妇稀释后浓度为20μg/mL的去氧肾上腺素150μg,泵入速度6μg/(kg?h),并根据产妇心率指标随时适当调节,手术结束前20 min结束输注.比较两组产妇不同时间点[入室(T0)、切子宫时(T1)、手术结束时(T2)]输液量、输血量、尿量、血容量、血浆容量以及不良反应发生情况.结果 研究组30例产妇在T1、T2时点输液量分别为(0.22±0.03)、(0.45±0.06)L,明显低于对照组[(0.77±0.04)、(1.40±0.04)L],差异有统计学意义(P<0.05),各指标不同时间点组内比较,差异有统计学意义(P<0.05);研究组产妇血容量及血浆容量在T1时点分别为(6.57±0.68)、(4.15±0.46)L,在T2时点分别为(6.54±0.71)、(4.24±0.49)L,均明显低于对照组产妇[(7.24±0.66)、(4.90±0.51)、(7.62±0.76)、(5.32±0.61)L],差异有统计学意义(P<0.05),血容量及血浆容量不同时间点组内比较,差异有统计学意义(P<0.05);研究组产妇低血压、恶心呕吐、胸闷发生率分别为10.00%、10.00%、0.00%,对照组产妇发生率分别为30.00%、30.00%、13.33%,研究组明显低于对照组,差异有统计学意义(P<0.05或P<0.01).结论 硬膜外麻醉下剖宫产产妇应用小剂量去氧肾上腺素,可以有效维持产妇容量的稳定,降低产妇低血压、恶心呕吐和胸闷的发生率.%Objective To study the effect of low-dose of phenylephrine on maternal capacity of cesarean section under epidural anesthesia. Methods 60 cases of grade ASAⅠ-Ⅱ term pregnancy women in the Fourth Hospital of Shiji-azhuang from January 2014 to January 2015 were selected, all patients were divided into control group and study group in according to random number table, with 30 patients in each group. Control group was given 6 mg ephedrine hy-drochloride injection in the event of hypotension to the end of surgery; study group was given 20 μg/mL of Phenyle-phrine after dilution when maternal blood pressure measured decreased twice continuously, pump rate 6μg/(kg?h), and adjusted the rate by the maternal heart rate indicator, ended the infusion before 20 minutes of the end of surgery. Transfusion, blood transfusion, urine, blood volume and plasma volume of two groups at different time points [entrance time (T0), cutting the uterus (T1), the end of surgery (T2)] were compared. Results The fluid volume and of study group were (0.22±0.03), (0.45±0.06) L respectedly at T1 and T2, these were significantly lower than those of the control group [(0.77±0.04), (1.40±0.04) L], the differences were statistically significant (P< 0.05), indicators at different time points in each group were compared, the differences were statistically significant (P<0.05); blood volume and plasma volume of study group were (6.57±0.68), (4.15±0.46) L respectively at T1, and (6.54±0.71), (4.24±0.49) respectively at T2, these were significantly lower than those of the control group [(7.24±0.66), (4.90±0.51), (7.62±0.76), (5.32±0.61) L], the dif-ferences were statistically significant (P < 0.05), the blood volume and plasma volume in each group at different time points were compared, the differences were statisti-cally significant (P<0.05); the rates of hypotension, nausea and vomiting, chest tightness of study group were 10.00%, 10.00%, 0.00% respectedly, and these of the control group was 30.00%, 30.00%, 13.33%, these of study group were significantly lower than thoses of the control group, the differences were statistically significant (P<0.05 or P<0.01). Conclusion Applying low-dose phenylephrine in cesarean section under epidural can reduce the degree of increase in maternal blood volume and plasma volume, reduce the incidence of maternal hypotension, nausea, vomiting and chest tightness.
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