联合去氧肾上腺素和麻黄素在产科麻醉中的应用

Application of combination of ephedrine and phenylephrine in the anesthesia during cesarean section

目的 探讨联合应用麻黄素和去氧肾上腺素对剖宫产术中产妇和新生儿的影响. 方法 选择ASAⅠ～Ⅱ级,无其他并发症择期足月妊娠剖宫产患者200例,随机分为5组,每组40 例. 麻醉后血压下降（较基础值低20%,或收缩压低于90 mmHg）的患者给予升压药物处理. A组给去氧肾上腺素100 μg;B组给麻黄素8 mg;C组给予麻黄素和去氧肾上腺素联合用药,其中C1组为麻黄素2 mg＋去氧肾上腺素75 μg,C2 组为麻黄素4 mg＋去氧肾上腺素50 μg,C3组为麻黄素6 mg＋去氧肾上腺素25 μg. 记录患者血压、心率值,使用升压药的次数、总剂量,给药后心动过速和心率过缓发生率,使用阿托品例数,记录产妇有无恶心、呕吐等不良反应的情况. 胎儿娩出后,取脐动脉血样本进行血气分析,测定脐血pH值、PCO2、PO2、血糖、乳酸值、HCO3、BE值. 记录新生儿出生后1 min、5 min的Apgar评分. 若患者血压不下降,不予处理,记录心率及胎儿脐血气值,作为对照.结果 A组患者心率减慢（P〈0.05）,但胎儿脐血气分析与未给药组比较差异无统计学意义（P〉0.05）. B组患者心率增快明显（P〈0.05）,恶心呕吐发生率高（P〈0.05）,且脐血气分析pH值、HCO3 值、BE值明显降低（P〈0.05）. C组心率较为平稳. 其中C2组心率、血压更为稳定,虽然HCO3 值较未给药组差异有统计学意义（ P〈0.05）,但较B组有优势（P〈0.05）. 胎儿娩出后Apgar评分比较差异无统计学意义. 结论 在剖宫产术中,联合应用麻黄素和去氧肾上腺素较单独使用其一改善血压、心率的效果更为良好,且对胎儿影响较小.

Objective To explore the effect on the parturients and newborns of combined use of ephedrine and phenylephrine in the cesarean section. Methods 200 ASAⅠ~Ⅱ patients with elective cesarean section who had no other complication were selected. The patients were randomly assigned to 5 groups,40 cases in each group. If the blood pressure decreased （ less than 20% compared with baseline,or systolic blood pressure less than 90 mmHg） ,vasopres-sors were given. Patients in group A received phenylephrine 100 μg;patients in group B used ephedrine 8 mg;patients in group C were given ephedrine and phenylephrine：group C1 received ephedrine 2 mg＋phenylephrine 75 μg,group C2 used ephedrine 4 mg＋phenylephrine 50 μg,group C3 received ephedrine 6 mg＋phenylephrine 25 μg. The patients′blood pressure,heart rate,as well as the frequency and total dose of the vasopressors,the incidences of tachycardia and bradycardia,the dosage of atropine, the rates of maternal nausea, vomiting and other adverse reactions were recor-ded. After the delivery,the umbilical artery blood samples were collected for blood gas analysis;the blood pH,PCO2 , PO2,plasma glucose,lactate,HCO3 and BE value were determined;the Apgar scores after 1 min,5 min were recor-ded. The patients whose blood pressure did not drop were given no treatment,the heart rate and fetal cord blood gas val-ues were recorded as control （group U）. Results The heart rate of the patients in group A reduced （P〈0.05）,but there was no significant difference in fetal cord blood analysis compared with group U （P〉0.05）. The heart rate of the patients in group B increased significantly （P〈0.05）,the incidence of nausea and vomiting was higher （P〈0.05）, the pH,HCO3 ,BE values in fetal cord blood analysis were lower （ P〈0.05 ） . The heart rate in group C was relative stable,and the heart rate and blood pressure in group C2 were more stable,although the HCO3 was lower than that of group U,it was higher than that of group B （P〈0.05）. There was no significant difference in Apgar score among the 5 groups （ P〉0.05 ） . Conclusion Combination of ephedrine and phenylephrine is better than single use to improve the heart rate and the blood pressure in the cesarean section with little effect on the newborns.