不同剂量去氧肾上腺素静脉注射对腰麻下剖宫产产妇及新生儿的影响

摘要

目的 观察不同剂量去氧肾上腺素静脉注射对腰麻下剖宫产产妇及新生儿的影响.方法 择期腰麻剖宫产单胎产妇60例,随机均分为三组,在蛛网膜下腔注入0.5％重比重布比卡因2.5 ml,鞘内注药后立即静脉泵注去氧肾上腺素150 μg(P1组)、300 μg(P2组)或等量生理盐水(C组)各3 ml,速率1 ml/mi1若发生低血压时追加去氧肾上腺素100μg.监测并记录产妇SBP、DBP、HR、每搏输出量(SV)和心输出量(CO),以及低血压、高血压、恶心呕吐及心动过缓的发生次数.记录新生儿Apgar评分,并取脐带动静脉血行血气分析.结果 与入室后比较,腰麻后1、5 min C组SBP、DBP明显降低(P＜0.05),P1、P2组无显著变化；腰麻后1、5min和分娩前1 min P1、P2组HR明显减慢,C组仅在分娩前1 min显著减慢(P＜0.05)；腰麻后1、5 min R2组SV显著升高,腰麻后5min C组显著降低(P＜0.05),且腰麻后5 min P1、P2组明显高于C组(P＜0.05)；腰麻后5 min和分娩前1 min P1、P2组CO显著降低(P＜0.05),分娩前1 min C组也显著降低(P＜0.05).P1组和P2组低血压的发生率显著低于C组(P＜0.05).P1组和P2组分别有1例和3例高血压.结论 小剂量去氧肾上腺素静脉输注能减少分娩前产妇低血压的发生率,对母体和胎儿影响较小.%Objective To observe the effects of different doses of phenylephrine on parturient and neonate during spinal anesthesia for cesarean section. Methods Sixty singleton gestation parturients, ASA Ⅰor Ⅱ and scheduled for elective cesarean section under spinal anesthesia were randomly divided into three groups ( n = 20); group P1: phenylephrine 150 μg, group P2: phenylephrine 300 jig. group C: saline. Immediately after spinal anesthesia, phenylephrine or saline was infused at the rate of 1 ml/min for 3 min. Additional phenylephrine 100 pig was applied in the presence of hypotension. SBP, DBP, HR, SV, CO were recorded. The frequency of hypotension, nausea and vomiting- and Apgar scores were also recorded. The umbilical artery and umbilical vein blood gases were analyzed. Results SBP and DBP decreased in group C but not in group P, and P2 1 min and 5 min after spinal anesthesia(P<0. 05). HR in P1 and P2 group decreased I min and 5 min after anesthesia and 1 min before delivery but HR in group C only decreased 1 min before, deliveryCP <0. 05). SV increased 1 min and 5 mm after anesthesia in group P2 but SV decreased 5 min after anesthesia in group C(P<0. 05). CO in the two groups decreased 5 min after anesthesia and 1 min before delivery but CO only decreased 1 min before delivery in group C. The incidence of hypotension was low in group P1 and P2 compared with group C(P<0. 05). One patient in group P1 and 3 in P2 developed to hypertension. Conclusion A small dose of phenylephrine infusion can reduce the incidence of maternal predelivery hypotension with minor adverse effects.