麻黄碱与去氧肾上腺素联合不同麻醉剂对剖宫产产妇麻醉质量与血流动力学的影响

The impact on anesthesia quality and hemodynamic of ephedrine and deoxyepinephrine combined with different anesthesia for cesarean section

目的探讨麻黄碱与去氧肾上腺素联合不同麻醉剂对剖宫产产妇麻醉质量与血流动力学的影响。方法回顾性分析2015年5-12月河北省优抚医院收治的126例择期剖宫产产妇的临床资料,均行腰-硬联合麻醉,采用随机数字表法分为3组,每组42例,分别泵入盐酸麻黄碱、去氧腺上腺素和不泵升压药物。比较3组麻醉效果、血流动力学、血气指标、不良反应。结果 ①麻醉效果：麻黄碱组和去氧肾上腺素组产妇感觉阻滞起效时间、达最高平面时间、持续时间,运动阻滞起效时间、最大阻滞时间、恢复时间比较,差异均无统计学意义（P〉0.05）。②血流动力学：麻醉2 min、5 min、8 min、切皮时、子宫切开时,麻黄碱组平均动脉压[（80.23±4.76、73.60±3.29、76.42±3.54、74.31±3.18、75.08±3.42）mm Hg]均低于去氧肾上腺素组[（84.36±4.48、77.21±4.13、81.35±4.68、83.09±4.51、85.13±4.24）mm Hg];心率[（103.25±7.13、101.46±6.24、93.28±5.16、99.31±6.04、98.16±5.73）次/min]快于去氧肾上腺素组[（90.36±5.21、87.42±5.09、79.06±4.63、81.23±4.80、80.35±4.32）次/min];左心排量高于去氧肾上腺素组;差异均有统计学意义（P〈0.05）。③血气指标：麻黄碱组脐动脉、脐静脉血的二氧化碳分压[（66.25±12.43、49.78±7.76）mm Hg]、乳酸浓度[（4.18±1.85、3.09±1.27）mmol/L]均高于去氧肾上腺素组[（57.34±7.18、45.63±4.93）mm Hg]、[（2.41±0.69、1.81±0.28）mmol/L],差异有统计学意义（P〈0.05）;④不良反应：麻黄碱组术中低血压、高血压及术后恶心呕吐等不良反应发生率（14.29%、47.62%、19.05%）均高于去氧肾上腺素组（2.38%、9.52%、2.38%）（P〈0.05）。结论联合应用麻黄碱与去氧肾上腺素均能保证剖宫产术麻醉质量,但去氧肾上腺素更有利于产妇的血流动力学稳定。

Objective To study effect of anesthesia quality and hemodynamic of ephedrine and deoxyepinephrine combined with different anesthesia for cesarean section.Methods Clinical data of 126 cases with cesarean section in Youfu Hospital of Hebei Province from May 2015 to December 2015 were analyzed retrospectively,divided into ephedrine group,deoxyepinephrine group and control group.Three groups were given combined spinal epidural anesthesia,pump-in ephedrine hydrochloride,pump-in deoxyepinephrine,nopressor agent respectively.Anesthesia effect,hemodynamics,blood gas index and adverse reactions were compared among the three groups.Result ①Anesthesia effects：there were no statistically difference of sensory block onset time,sensory block onset highest plane time,sensory block maintaining time,motion block onset time,motion maximum block time,motion block recovery time between ephedrine group and deoxyepinephrine group（P〉0.05）;② Hemodynamic：anesthesia 2 min,5 min,8 min,cut skin,uterine incision,MAP values of ephedrine group patients[（80.23 ± 4.76,73.60 ± 3.29,76.42 ± 3.54,74.31 ± 3.18,75.08 ± 3.42） mm Hg]were significantly lower than the deoxyepinephrine group[（84.36 ± 4.48,77.21 ± 4.13,81.35 ± 4.68,83.09 ± 4.51,85.13 ± 4.24）mm Hg],HR[（103.25 ± 7.13,101.46 ± 6.24,93.28 ± 5.16,99.31 ± 6.04,98.16 ± 5.73）/min]were significantly faster than the deoxyepinephrine group [（90.36 ± 5.21,87.42 ± 5.09,79.06 ± 4.63,81.23 ± 4.80,80.35 ± 4.32）/min]（P〈0.05）;③ Blood gas index：umbilical artery,umblical venous（PCO2） [（66.25 ± 12.43,49.78 ± 7.76） mm Hg],lactic acid concentration [（4.18 ±1.85,3.09 ± 1.27） mmol/L]of ephedrine group were significantly higher than those of deoxyepinephrine group（[（57.34 ± 7.18,45.63 ± 4.93） mm Hg],[（2.41 ± 0.69,1.81 ± 0.28） mmol/L]（P〈0.05）;④ the occurrence rate of hypotension and hypertension during operation,nausea and vomiting etc adverse reactions postoperation of ephedrine group（14.29%,47.62%,19.05%） were significantly higher than the deoxyepinephrine group（2.38%,9.52%,2.38%）（P〈0.05）.Conclusion Combining ephedrine with deoxyepinephrine can ensure the anesthesia quality of cesarean section,but deoxyepinephrine has more advantages to maternal hemodynamic stability.