不同剂量麻黄碱联合羟乙基淀粉预扩容预防腰硬联合麻醉剖宫产术中低血压的效果观察

Comparison of different doses of ephedrine combined with hydroxyethyl starch as a volume preload for pre- venting hypotension in caesarean section before combined spinal and epidural anesthesia

目的探讨不同剂量麻黄碱联合羟乙基淀粉预扩容对预防腰硬联合麻醉剖宫产术低血压的效果。方法选取足月单胎需行剖宫产术的产妇250例，简单随机化法分为对照组与观察组（观察组分A、B、C、D四组），每组50例。对照组输注复方乳酸钠注射液250ml；观察四组均输注250ml羟乙基淀粉，A组加麻黄碱5mg、B组加10mg、c组加15mg、D组加20mg。比较五组产妇手术期间收缩压（SBP）、心率（HR）、不良反应等情况。结果A组SBP在麻醉完成后平卧（T1）、消毒（T2）、子宫复原（T，）时与麻醉操作前（T0）时比较下降较为明显[（111．8±17．18）mmHg、（114．58±19．80）mmHg、（115．06±10．39）mmHg与（120．88±13．24）IrlmHg，均P〈0．05]，在T1、胎儿取出（T4）、缝皮（T6）时点与B、C、D组比较差异均有统计学意义[（111．8±17．18）mmHg与（120．78±14．47）mmHg、（118．56±14．25）mmHg、（118．42±18．71）mmHg，（125．58±14．45）mmHg与（120．02±21．15）mmHg、（115．92±17．56）mmHg、（119．00±12．49）mmHg，（118．08±9．09）mmHg与（121．52±10．92）mmHg、（116．04±11．61）mmHg、（124．98±9．16）mmHg，均P〈0．05]；HR在T1、T5时与Tn时比较稍有波动（P〈0．05），在T1、切皮（T3）、T4、T6时点与C、D组比较差异均有统计学意义[（82．92±19．55）次／min与（98．86±17．82）次／min、（96．72±17．91）次／min，（89．04±16．68）次／min与（92．10±16．55）次／min、（98．46±19．49）次／min，（87．56±17．13）次／min与（98．86±16．76）次／min、（88．58±19．22）次／min。（93．20±14．07）次／min与（98．804-11．69）次／min、（90．98±10．93）次／min，均P〈0．05]。B组及C组手术全程SBP、HR较为平稳，且不良反应少；D组SBP虽然较为平稳，但HR在手术全程中明显增快（P〈0．05），且在T4、k时点与B、c组比较差异有统计学意义（P〈0．01）。结论麻黄碱的适宜剂量是10—15mg，联合羟乙基淀粉预扩容能维持患者循环稳定。

Objective To evaluate the effects of different doses of ephedrine combined with hydroxyethyl starch as a volume preload for preventing hypotension in caesarean section before combined spinal and epidural anes- thesia. Methods 250 pregnant wemen undergoing cesarean section were randomly allocated into the control group （n =50） and the observation group（n =200）（group was divided into A,B,C,D group,each group 50 cases）. Con- trol group preloaded Lactated Ringer＇s solution 250ml before CSEA. A group preloaded hydroxyethyl starch combined with 5mg ephedrine; B group preloaded hydroxyethyl starch combined with 10mg ephedrine. C group preloaded hydroxyethyl starch combined with 15mg ephedrine; D group preloaded hydroxyethyl starch combined with 15rag e- phedrine. The parturient SBP, HR and untoward reaction were monitored in five experimental groups. Results Compared with To A group parturient SBP was lower at T1 , T2, T5 [ （ 111.8± 17.18）mm Hg, （ 114.58 ± 19.80 ） mm Hg, （ 115.06 ±10.39） mm Hg vs （ 120.88 ±13.24） mm Hg, all P 〈 0.05 ） ]. Compared with B, C, D group, statistical differences were found at T1, T4,T6 [ （ 111.8 ± 17.18） mm Hg vs （ 120.78 ± 14.47） mm Hg, （ 118.56 ± 14.25） mm Hg, （ 118.42 ± 18.71 ） mm Hg. （ 125.58±14.45 ） mm Hg vs （ 120.02 ±21. 15 ） mm Hg, （ 115.92 ± 17.56） mm Hg, （ 119.00± 12.49） mm Hg. （ 118.08 ± 9.09 ） mm Hg vs （ 121.52± 10.92 ） mm Hg, （ 116.04± 11.61 ） mm Hg, （ 124.98± 29.16）ram Hg,all P 〈0.05]. Compared with To parturient HR was undulation at T1 ,T5 （P 〈0.05）. Compared with C, D group, statistical differences were found at T1, T3, T4, T6 [ （82.92± 19.55 ）times/min vs （98.86 ±17.82） times/min, （96.72±17.91 ） times/rain. （ 89.04 ± 16.68 ） times/min vs （ 92. 10± 16.55 ） times/min,（98.46±19.49） times/min. （87.56 ± 17.13） times/min vs （ 98.86 ± 16.76） times/min, （ 88.58± 19.22） times/min. （93.20± 14.07） times/min vs （98.80 ± 11.69） times/min, （90.98 ±10.93 ） times/min, all P 〈 0.05 ]. In B and C group, parturient SBP and HR were steady and the untoward reaction was very few. Although parturient SBP of D group was steady, but HR obviously fast during operation （ P 〈 0.05 ）. Compared with B, C group, statistical differences were found at T4, T6 （ P 〈 0.01 ）. Conclusion The optimum dose is 10 - 15 mg of ephedrine. It combined with hydroxyeth- yl starch as a volume preload can keep the stable of blood circulation.