去氧肾上腺素防治剖宫产腰麻后低血压的效果观察

The effectiveness of Phenylephrine prevention hypotension by spinal anesthesia for cesarean section

目的:观察持续输注去氧肾上腺素防治剖宫产腰麻后低血压的效果及安全性。方法:选择ASAⅠ～Ⅱ级,年龄20～32岁的剖宫产术患者60例,全部患者入室后输入复方乳酸钠注射液,输液速度为15～20ml/(kg·h)。将60例患者随机等分两组,A组为对照组,行腰硬联合麻醉,腰麻成功后调整患者体位为15°～20°的左倾斜位至切皮前;B组为观察组,腰麻成功后立即按100μg/ml的速率静脉输注去氧肾上腺素2min,然后按0.3～0.5μg/(kg·min)的速率持续输入至胎儿娩出,余方法同A组。观察两组患者麻醉前及麻醉后2、5、8、10、15、20、25min的SBP,记录低血压的发生率、恶心呕吐发生率及新生儿1min和5min的Apgar评分。结果:A组麻醉后SBP5min及20min下降剧烈,组内与麻醉前比较,P<0.01,组间比较,P<0.01;B组麻醉后血压平稳,组内与麻醉前比较,P>0.05;低血压的发生率及恶心、呕吐发生率A组明显高于B组,P<0.01;两组新生儿1min和5minApgar评分均在正常范围,组间比较,P>0.05。结论:持续输注去氧肾上腺素防治剖宫产腰麻后低血压是一种安全有效的方法。

Objective：To investigate the efficacy and security of continuous infusion Phenylephrine which were used to prevent hypotension by spinal anesthesia for cesarean section.Methods：60 cesarean section patients,ASA gradeⅠ to Ⅱ,age 20 to 32,were injected lactated Ringers solution at the rate of 15-20 ml/（kg·h）.60 patients were randomly divided into two groups.Group A for the control group,was used combined-spinal-epidural anesthesia,after spinal anesthesia suc cessful,was adjusted the position of patients title to the left at 15°-20° before skin incision.Group B for the observation group,after spinal anesthesia successful,was immediately injected Phenylephrine at the rate of 100 μg/ml by 2 min,then injected the Phenylephrine at the rate of 0.3-0.5 μg/（kg·min） until parturition end,other methods were the same as group A.After anesthesia,SBP of two group patients were observed respectively at 2,5,8,10,15,20,25 min,and recorded the incidence of hypotension,nausea,vomiting and the Apgar score of neonates in 1 and 5 min.Results：After anesthesia,SBP of group A was dramatically decline in 5 and 20 min,compared with that before anesthesia,and compared with group B,the difference was statistically significant,all P〈0.01.After anesthesia,the blood pressure of group B was stable,compared with that before anesthesia,P〉0.05.The incidence of hypotension,nausea,vomiting of group A was higher than group B,P〈0.01.Apgar scores of two groups were normal in 1 and 5 min,P〉0.05.Conclusion：Continuous infusion of Phenylephrine to prevent hypotension by spinal anesthesia for cesarean section is a safety and effective method.