多巴胺预注与麻黄碱静注对剖宫产腰麻低血压的防治

Preventive effect of dopamine injected preliminarily and ephedrine injected intermittent on spinal anesthesia-associated hypotension in cesarean patients

目的:探讨小剂量多巴胺微量泵预注与麻黄碱间断静注对剖宫产腰麻低血压的防治效果。方法:ASAI或II级产妇60例,随机分为A、B两组,每组30例。A组微量泵预注多巴胺1～3μg(/kg·min),B组输注乳酸林格氏液,在SBP低于90mmHg或低于基础血压30%时,A组将多巴胺剂量增加至4～6μg(/kg·min);B组静注麻黄碱10～15mg,观察记录记腰麻注射后即刻到切开子宫时间,麻醉手术时间以及麻醉前(T1),麻醉后3min(T2)、5min(T3)、10min(T4)、胎儿取出后1min(T5)、胎儿取出后3min(T6)及术毕(T7)各时间点MAP及HR的数值,统计记录麻醉手术过程中产妇发生恶心呕吐、胸闷气短、心慌、头晕头疼情况。结果:A组产妇的MAP在T2、T3、T6时点上比B组高(P<0.05),HR在T3、T4、T6时点上A组变化低于B组(P<0.05);两组患者发生恶心呕吐、心慌胸闷等不良反应率B组均高于A组(P<0.01)。结论:小剂量多巴胺微量泵预注比麻黄碱间断静注更能使腰麻下剖宫产患者的血流动力学维持稳定,减少不良反应的发生。

Objective： To compare the preventive effect of small dose of dopamine injected preliminarily by TCI（target control infusion） and ephedrine injected intermittent on spinal anesthesia-associated hypotension in cesarean patients. Methods： Sixty ASA I or II patients were randomly divided into A and B with 30 eases for each. Dopamine was injcted preliminarily 1- 3μg/（kg·min） by TCI in group A, and Pinger＇s solution was injcted in group B.When the blood pressure was below 90mmHg in SBP or the baseline 30%, the dose of dopamine＇was increased to 4-6μg/（kg·min） in gruop A, ephedrine was injected 10-15rag in group B. MAP and HR were recorded at the time before anesthesia （Ti）,3,5,10 minutes （T2-T4）,and anesthesia, 1,3minutes （T2-T4） after fetal removing,and completion of operation （T7）. Patients＇ situation of nausea ,vomiting, chest distress,dizziness and headache were also recorded during operation. Results： The MAP in the group A was higher than group B at T2, T3, T6 point （P〈0,05）.The HR in the group A was lower than group B at T3, T4, T6 point （P〈0.05）. The harmful response rate in group B was higher than group A（P〈0.01 ）. Conclusion： Small dose of dopamine injected preliminarily by TCI has more stable matemal hemodynamies than ephedrine injected intermittent on spinal anesthesia-associated hypotension in cesarean patients,and reduces the occurrence of adverse reactions.