麻黄碱及甲氧明用于剖宫产腰麻低血压的防治

Preventive effect of ephedrine and methoxamine on spinal anesthesia-associated hypotension in Cesarean patients

目的比较麻黄碱与甲氧明用于剖宫产腰麻低血压的防治效果。方法 90例择期腰麻剖宫产产妇随机分为三组,当腰麻后血压低于80%基础值时分别静注麻黄碱12 mg(E组)、甲氧明2 mg(M组)或麻黄碱6 mg+甲氧明1 mg(EM组)。观察各组产妇腰麻后血流动力学变化,测定胎儿取出后脐动脉血气值。结果三组SBP差异无明显统计学意义。HR<60次/分的产妇M组11例(23.3%),显著多于E组的0例和EM组的1例(3.3%)(P<0.05);HR>100次/分的产妇E组11例(36.7%),显著多于M组(0例)及EM组(0例)(P<0.05)。胎儿娩出后1、5 min的Apgar评分三组间差异无统计学意义。脐动脉pH值E组显著低于M组及EM组(P<0.05);脐动脉BE值E组显著高于M组及EM组(P<0.05)。结论麻黄碱与甲氧明单独或联合均可有效防治剖宫产腰麻后低血压发生,但麻黄碱与甲氧明联合使血流动力学更稳定,甲氧明单用与甲氧明与麻黄碱联合应用使胎儿酸碱平衡更稳定。

Objective To compare the preventive effect of ephedrine and methoxamine on spinal anesthesia-associated hypotension in Caesarean patients. Methods Ninety women undergoing elective Cesarean section under spinal anesthesia were randomly allocated to three groups with 30 each, following drugs were given when the blood pressure was below the baseline 80%.. 12 mg ephedrine （group E）, 2 mg methoxamine （group M）, or 6rag ephedrine plus lmg methoxamine （group EM）. The changes in maternal hemodynamics and infant blood gases were measured. Results No changes were observed in systolic blood pressure among the three groups. Eleven women （23.3%） experienced bradycardia with HR^60 bpm in the group M, but none in the group E （P〈0. 05）; 11 （36.7%） encountered tachycardia with HR〉100 bpm in the group E, but none in the groups of M and EM （P〈 0.05）. 1 and 5 min Apgar scores were similar in the three groups. Umbilical artery pH in the group E was significantly lower than the other two groups （P〈 0. 05 ）, but the base excess in the group E was significantly higher than the other comparisons （P〈0. 05）. Conclusion Ephedrine and methoxamine used single or in combination all can produce effective prevention of the maternal hypotension after spinal anesthesia in Cesarean patients, but EM has more stable maternal hemodynamics, and M and EM have more stable infant acid-base.