麻黄碱在剖宫产术腰硬联合麻醉中的应用

Application of Ephedrine in Combined Spinal-Epidural Anesthesia for Cesarean Section

目的比较麻黄碱在剖宫产术腰硬联合麻醉中的两种用法。方法选择行剖宫产术产妇80例,ASAⅠ～Ⅲ级,腰硬联合麻醉后行随机双盲法分为两组,A组:平均动脉压(MBP)<75 mm Hg或下降幅度超过基础血压的15%,静脉注射麻黄碱15 mg。B组:心率(HR)<60次/min或下降幅度超过基础心率的15%,静脉注射麻黄碱15 mg。记录麻醉前(T0)、麻醉后1 min(T1)、3 min(T2)、5 min(T3)、10 min(T4)、20 min(T5)各时点的平均动脉压(MBP)、心率(HR)的变化;记录术中使用麻黄碱的总用量;记录低血压、恶心及呕吐等不良反应的发生率;记录新生儿出生时的Apgar评分。结果 T1、T2、T3时A组的MBP、HR与T0比较差异有统计学意义(P<0.05),T1、T2、T3时A组与B组的MBP、HR比较差异有统计学意义(P<0.05)。B组与A组比较麻黄碱用量明显减少(P<0.05)。结论根据产妇麻醉后心率的变化使用麻黄碱,更迅速有效地预防低血压和恶心呕吐的发生,减少麻黄碱的用量,保障产妇及新生儿的安全。

Objective To investigate the application of ephedrine in combined spinal-epidural anesthesia（CSEA） for cesare- an section. Methods Eighty parturient undergoing cesarean section（ASA I - HI ） were randomly divided into two groups after CSEA. Group A received 15 mg ephedrine injection immediately after MBP was less than 75 mm Hg or the MBP decreased excee- ding 15% of their basic SBP. Group B reeeived 15 mg ephedrine immediately after HR was less than 60 bpm or the HR decrease exceeding 15 % of their basic HR. The MBP and HR at different time points, total dose of ephedrine, rate of adverse reactions （ hy- potension, nausea and vomiting）, Apgar scoring for neonates were recorded. Results In group A, the difference in MBP and HR at Tl , T2 and T3 time points was statistically significant as compared to TO （ P 〈 0.05 ） ; the difference in MBP and HR at T1 , T2 and T3 time points was statistically significant between group A and B （ P 〈 0.05 ）. The dosage of ephedrine in group A was lower than that in group B （ P 〈 0.05 ）. Conclusion Taking the changes of HR after anesthesia as the reference of adjusting the dose of ephedrine,we can effectively prevent the occurring of hypotension, nausea and vomiting, decrease the dose of ephedrine, and in- crease the safety of parturient and neonates.