两种升血压药对腰硬联合麻醉下剖宫产分娩的影响

Ephedrine and dopamine＇s hypotension-preventative effect for CSEA in cesarean delivery-A single-blind controlled study

目的：比较剖宫产手术时，麻黄碱和多巴胺在预防腰硬联合麻醉下发生低血压的效果，并评价两种药物对母体和对胎儿的影响。方法将103例ASAⅠ或Ⅱ级择期在腰硬联合麻醉下行剖宫产的产妇分成两组，麻黄碱组（51例）预防性应用麻黄碱10 mg静脉注射，多巴胺组（52例）应用多巴胺5μg·kg^－1· min^－1静脉泵入。观察产妇不良反应、评价新生儿出生后1 min及5 min的Apgar评分，同时行脐动、静脉血气分析。结果麻黄碱组低血压发生率为43．1％，低于多巴胺组的69．2％（χ^2＝7．06，P＝0．00）；麻黄碱组胎儿脐动脉血pH值（7．22±0．03），低于多巴胺组的（7．27±0．06）（t＝0．62，P＝0．02）；麻黄碱组新生儿出生后1 min判定为新生儿窒息者有16例，明显高于多巴胺组的6例（χ^2＝5．79，P＝0．01，OR＝1．68，95％ CI＝1．18～2．41），脐静脉血pH值及新生儿5 min Apgar评分≤7分者两组差异均无统计学意义。结论麻黄碱较多巴胺更能有效预防腰硬联合麻醉下剖宫产产妇低血压的发生，但多巴胺对胎儿影响较小。

Objective To compare the effects of ephedrine and dopamine in the prevention of hypotension during combined spinal and epidural anesthesia （CSEA）for cesarean delivery.Methods Fifty ASAⅠorⅡ patients undergoing elective cesarean delivery were randomly divided into the two groups,Ephedrine group （n=5 1 ）：intrave-nous injection of 10mg ephedrine before anesthesia;Dopamine group（n=52）：continuous intravenous infusion at the speed of 5μg·kg-1 ·min-1 .During the whole process,we investigated the incidence rate of adverse effects,com-pared the Apgar score of neonate and analyzed blood gas of umbilical artery and vein.Results Compare to the dopa-mine group,the incidence rate of hypotension was lower in the ephedrine group （43.1% vs 69.2%,χ^2 =7.06,P=0.00）.The pH value of umbilical artery and 1 min Apgar score of neonate in the ephedrine group was lower compare with that in the dopamine group[（7.22 ±0.03）vs （7.27 ±0.06）,t=0.62,P=0.02],there are no significant difference of 5 min Apgar score in the two groups.Conclusion Compared with dopamine,ephedrine is a useful drug in the prevention of hypotension during combined spinal and epidural anesthesia （CSEA）for cesarean delivery and there are no significant differences of adverse effects of dopamine and ephedrine.Ephedrine has transient effect on the neonate,while the effect of dopamine is minor.