剖宫产脊麻后预防性静注麻黄碱对胎儿脐动脉血气的影响

Effect of pretreatment with ephedrine on umbilical artery blood gas to prevent hypotension following spinal anesthesia for cesarean section

目的观察剖宫产脊麻后预防性静脉注射麻黄碱对胎儿脐动脉血气的影响。方法选择拟择期于脊麻下行剖宫产术的产妇120例,ASAⅠ~Ⅱ级,随机分为实验组（E组,60例）和对照组（N组,60例）。所有产妇均选择L3-4间隙行蛛网膜下腔-硬膜外联合穿刺,蛛网膜下腔给予0.5%布比卡因1.3 mL。产妇平卧后E组即刻给予麻黄碱10 mg,N组相应给予等容生理盐水。记录产妇心率、血压、血氧饱和度、心电图,观察产妇恶心、呕吐、头晕等不适发生情况,同时检测胎儿脐动脉血气并进行新生儿Apgar评分。结果 E组收缩压最低值显著高于N组（P〈0.05）,心率最高值比较差异无统计学意义（P〉0.05）;E组产妇术中恶心、呕吐、头晕等不适的发生率明显低于N组（P〈0.05）;E组胎儿脐动脉血气PO2高于N组（P〈0.05）,PCO2、pH差异均无统计学意义（P〉0.05）。结论麻黄碱预防性给药可有效预防剖宫产术脊麻后低血压,减少产妇不适并提高胎儿脐动脉氧分压。

Objective To observe the effect of pretreatment with ephedrine on umbilical artery blood gas to prevent hypotension following spinal anesthesia for cesarean section.Methods 120 parturients,ASA Ⅰ ~ Ⅱ,under spinal anesthesia for cesarean section were equally randomized into ephedrine group（n=60） and control group（n =60）.0.5% bupivacaine 1.3 mL was given through subarachnoid space after successfully puncture in L3-4 intervertebral space.Ephedrine 10 mg was injected intravenously in group E and the same volume saline was injected in group N after prostrated immediately.The heart rate,blood pressure,electrocardiogram were recorded,nausea,vomiting and dizziness were observed,at the same time,umbilical artery blood gas was detected and Apgar score of neonate was assessed.Results The minimum value of systolic pressure in group E was higher than that in group N（P0.05）,and there was no significant difference in heart rate between the two groups（P0.05）.The incidences of nausea,vomiting and dizziness in group E were lower than those in group N（P0.05）.The PO2 of umbilical artery blood in group E was higher than group N（P0.05）,and there was no significant difference in PCO2,pH between the two groups（P0.05）.Conclusion Pretreatment with ephedrine can effectively prevent hypotension following spinal anesthesia for cesarean,decrease the parturient＇s uncomfortable experience and increase the PO2 of umbilical artery blood gas.