预注小剂量间羟胺对缩宫素所致剖宫产产妇血流动力学变化的影响

Effects of small dose of aramine pre-injection on hemodynamic fluctuations caused by administration of oxytocin during cesarean section

目的 探讨腰麻下剖宫产术中预注小剂量间羟胺对缩宫素所致血流动力学变化的影响.方法 腰麻下行剖宫产术且同意术中连续心排血量（CO）监测产妇40例,随机分为O组和A组,每组20例.结扎脐带前O组和A组分别静注生理盐水1 ml和间羟胺0.25 mg（1 ml）.结扎脐带后两组均注射缩宫素10U（1ml）.记录注射缩宫素后300 s内产妇的HR、MAP、CO和体循环阻力（SVR）的变化.结果 与注射缩宫素前即刻（0 s）比较,注射缩宫素后40～120 s时O组MAP明显降低（P＜0.01）,而A组各时点均无明显变化;20～90 s时O组HR逐渐增快（P＜0.01）,而A组HR变化比较平缓,且明显慢于O组（P＜0.01）;20～90 s时产妇CO均明显增加（P＜0.01）,但A组明显低于O组（P＜0.01）;20～240 s时O组SVR明显降低（P＜0.01）,而A组SVR明显高于O组（P＜0.01）.结论 腰麻下行剖宫产术中预注小剂量间羟胺可抵消缩宫素对心血管的不良反应,平稳血流动力学的波动.

Objective To observe the effects of small dose of aramine pre-injection on hemody- namic fluctuations caused by administration of oxytocin during cesarean section under spinal anesthe sia. Methods Forty patients undergoing selective cesarean section under spinal anesthesia were as signed randomly to one of the two groups： group O received 0. 9% normal saline 1 ml before umbilical occlusion, and group A received aramine 0.25 mg （1 ml） before umbilical occlusion. Both group O and group A received oxytocin 10 U （1 ml） after umbilical occlusion. Hemodynamic parameters were con tinuously obtained at 9 main time-points. Results After oxytocin injection, MAP of group O dramat- ically declined at 40-120 s （P〈0.01）, while MAP were stable at every time-point compared with 0 s in group A. Compared to 0 s, HR was significantly increased at 20-90 s in group O （P〈0. 01）, while HR at the other time-points were no significantly difference in group A compared with 0 s. CO was dramatically increased at 20-90 s compared with 0 s in both groups （P〈0.01）, but the increase of the former was significantly increase compared with group A （P〈0.01）. In group O , SVR significantly decreased at 20-240 s compared with 0 s, while SVR was no significantly difference at 20-90 s in group A. Conclusion Intravenous pre-injection of small dose of aramine can ameliorate hemodynamic fluctuations during cesarean section under spinal anesthesia