麻黄碱皮下局部浸润麻醉对剖宫产腰硬联合麻醉后低血压的预防效果观察

Prevention effect of ephedrine subcutaneous local anesthesia on hypotension after combined spinal epidural anesthesia in cesarean section

目的 探讨麻黄碱皮下局部浸润麻醉对剖宫产腰硬联合麻醉后低血压的预防效果。方法 选取义乌市第二人民医院2014年1月~2015年5月收治的剖宫产产妇80例,按照入院先后顺序随机分为治疗组（n=42）和对照组（n=38）。对照组实施腰硬联合麻醉,同时进行液体同步负荷,注射2μg/kg高渗氯化钠羟乙基淀粉,治疗组在对照组基础上加入15 mg麻黄碱皮下局部浸润。记录2组产妇平均动脉压（mean arterial pressure,MAP）、心率（heart rate,HR）和不良反应情况,检测血清C反应蛋白（C-reactive protein,CRP）、TNF-α水平,并于新生儿出生1、5 min后进行Apger评分。结果 麻醉后对照组T2-T4MAP水平低于T0（P〈0.05）,但治疗组麻醉前后各时点差异无统计学意义。与对照组比较,治疗组新生儿出生1 min时的Apgar评分较高（P〈0.05）,血清CRP、TNF-α水平较低（P〈0.05）。2组不良反应发生率差异无统计学意义。结论 麻黄碱皮下局部浸润麻醉可有效预防剖宫产腰硬联合麻醉后低血压的发生。

Objective To investigate the effect of ephedrine subcutaneous local anesthe on hypotension after combined spinal epidural anesthesia in cesarean section. Methods 80 cases of caesarean section were selected and randomly divided into control group （ n = 38 ） and treatment group （ n = 42）. Control group were treated with combined spinal epidural anesthesia, simultaneous injection with 2 μg/kg hypertonic sodium chloride hydroxyethyl starch, treatment group were added 15mg subcutaneous local infiltration of ephedrine on the basis of control group. Mean arterial pressure （ MAP）, heart rate （HR） and adverse reactions, serum CRP, TNF-ot levels, and after 1 min, 5 min Apgar scores of newborns were detected and compared between two groups. Results T2-T4 MAP levels in control group after anesthesia were lower than To （ P 〈 0. 05 ）, but treatment group had no significant difference among each time point before and after anesthesia. Compared with control group, 1 rain Apgar score of newborn born was higher in treatment group （P 〈 0.05 ）, serum CRP, TNF-α levels were lower （P 〈 0. 05 ） . The incidence of adverse reactions was no significant difference between two groups. Conclusion Ephedrine subcutaneous local infiltration anesthesia can be effective in preventing hypotension post-cesarean epidural anesthesia.