预防性静脉注射去氧肾上腺素和麻黄碱对腰硬联合麻醉剖宫产产妇及胎儿的影响

Effect of Prophylactic Phenylephrine and Ephedrine on Parturients and Fetus Undergoing Cesarean Delivery under Combined Spinal Epidural Anesthesia

目的探讨预防性静脉注射去氧肾上腺素和麻黄碱对腰硬联合麻醉剖宫产产妇及胎儿的影响。方法择期行子宫下段剖宫产术的单胎、足月产妇100例,ASAⅠ或Ⅱ级,随机分为两组(n=50):麻黄碱组(E组)和去氧肾上腺素组(P组)。E组椎管内注射局麻药同时静脉注射麻黄碱5 mg,用微量泵持续静脉输注麻黄碱0.83 mg.min-1至胎儿娩出;P组椎管内注射局麻药同时静脉注射去氧肾上腺素60μg,用微量泵持续静脉输注去氧肾上腺素16.7μg.min-1至胎儿娩出。采集脐动脉和脐静脉血样行血气分析。记录麻醉诱导至胎儿娩出时间、切皮至胎儿娩出时间、子宫切开至胎儿娩出时间(分娩时间)、新生儿1、5min Apger评分。记录产妇不良反应的发生情况(如高血压、低血压、窦性心动过缓、窦性心动过速、恶心呕吐)。结果两组麻醉诱导至胎儿娩出时间,切皮至胎儿娩出时间,子宫切开至胎儿娩出时间比较差异无统计学意义(P>0.05);与E组比较,P组胎儿脐动脉和脐静脉血pH值和BE差异无统计学意义(P>0.05);两组产妇低血压发生率比较差异无统计学意义(P>0.05);与E组比较,P组恶心、呕吐发生率降低(P<0.05)。结论预防性静脉注射去氧肾上腺素和麻黄碱可有效降低腰硬联合麻醉剖宫产产妇低血压发生率,且对胎儿无明显影响。预防性静脉注射去氧肾上腺素可以降低产妇恶心和呕吐。

Objective To investigate the effect of prophylactic phenylephrine and ephedrine on parturients and fetus undergoing cesarean delivery under combined spinal epidural anesthesia.Methods 100 ASA Ⅰ-Ⅱterm parturients undergoing cesarean delivery under combined spinal epidural anesthesia.were randomly divided into 2 groups（n=50 each）：group E ephedrine and group P phenylephrine.Group E received boluses of ephedrine 5mg and then was titrated at 0.83mg·min-1 from induction of spinal anesthesia until delivery.Group preceived boluses of phenylephrine 60mg and then was titrated at 16.7μg·min-1 from induction of spinal anesthesia until delivery.Induction of spinal anesthesia to delivery time,incision to delivery time,uterine incision to delivery time were recorded.Blood sample were taken from umbilical arterial and umbilical venous for blood gas analysis.Parturient adverse effects were recorded.Apgar score at 1 and 5min were evaluated.Results There was no significant difference in induction of spinal anesthesia to-delivery time,incision-to-delivery time,uterine incision-to-delivery time between two groups（P〉0.05）.Compared with group E,fetal pH and base excess showed no significant difference in group P（P〈0.05）.There was no significant difference in the incidence of hypotension between two groups（P〉0.05）.Compared with group E,the incidence of nausea and vomiting were significantly decreased in group P（P〈0.05）.Conclusion Prophylactic phenylephrine and ephedrine can decrease the incidence of maternal hypotension during combined spinal epidural anesthesia for caesarean delivery.Prophylactic phenylephrine reduced the incidence of nausea and vomiting.Prophylactic phenylephrine and ephedrine had no effect on fetus.