小剂量去氧肾上腺素对硬膜外麻醉下剖宫产产妇循环容量的影响

Effects of small-dose phenylephrine on capacity of circulation in parturients receiving cesarean section with epidural anesthesia

目的分析剖宫产的产妇在硬膜外麻醉后手术条件下应用小剂量去氧肾上腺素对其循环容量分布的影响。方法选取63例行硬膜外麻醉后剖宫产的产妇,随机分为观察组32例和对照组31例。术中对照组输入胶体液以维持循环容量,观察组联合输入去氧肾上腺素。记录产妇在入室、给药后10 min及子宫剖开、胎儿取出时、取出后10 min,至手术结束产妇的平均动脉压及心率变化。测定2组产妇各时间段血液中血容量,血浆容量及血红蛋白、红细胞压积变化,并记录产妇术中不良反应发生情况。结果观察组产妇在给药后10 min~手术结束时的平均动脉压与产妇入室时比较均有所降低,但差异无统计学意义(P>0.05),对照组产妇在子宫剖开时、胎儿取出时及取出后10 min内的平均动脉压与产妇入室时比较,均显著降低(P<0.05);观察组产妇在各时间点的心率变化差异无统计学意义(P>0.05),对照组产妇在子宫剖开时和胎儿取出时,心率显著升高(P<0.05);观察组产妇在给药后10 min~手术结束时的血容量,血浆容量及血红蛋白、红细胞压积与产妇入室时比较,差异无统计学意义(P>0.05),但对照组产妇在子宫剖开时、胎儿取出时及取出后10 min内的血容量和血浆容量与产妇入室时比较,均显著升高(P<0.05),血红蛋白和红细胞压积显著下降(P<0.05),观察组产妇的不良反应发生率为9.38%,对照组为16.13%,2组不良反应发生率比较差异无统计学意义(χ2=0.5023,P=0.4785)。结论小剂量去氧肾上腺素对剖宫产的产妇有较好维持心率、血压稳定的作用,可以减少胶体对血液的稀释造成的过度扩容,应用安全性较高,不良作用小,适合临床产妇应用。

Objective To investigate the effects of small-dose phenylephrine on of circulation capacity distribution in parturients receiving cesarean section with epidural anesthesia. Methods Sixty-three parturients who underwent cesarean section with epidural anesthesia were randomly divided into observation group（ n = 32） and control group（ n = 31）. The parturients in control group were given colloidal fluid to keep circulation capacity during operation,however,the parturients in observation group were given colloidal fluid ＋ phenylephrine during operation. The changes of blood pressure and heart rate,blood volume,plasma volume,hemoglobin,red cell volume were observed and compared between two groups on admiting into operation room,at 10 min after administration,on openning womb,during fetus being taken out,at 10 min after fetus was taken out,at the end of operation. And the adverse reactions during operation were observed for both groups. Results The mean arterial pressure in observation group was decreased from 10 min after administration to the end of surgery,as compared with that on admiting into operation room,however,the difference was not statistically significant（ P〉 0. 05）,but which in control group on admiting into operation room was significantly decerased,as compared with that on openning womb,during fetus being taken out,at 10 min after fetus was taken out（ P〈 0. 05）. There were no significant differences in the changes of heart rate in different time points in observation group（ P〉 0. 05）,however,the heart rate in control group on openning womb and during fetus being taken out was significantly increased（ P〈 0. 05）. There werer no significant differences in blood volume,plasma volume,hemoglobin,red cell volume from 10 min after administration to the end of surgery in observation group,as compared with those on admiting into operation room（ P〉 0. 05）,however,the blood volume and plasma volume on openning womb,during fetus being taken out,at 10 min after fetus was taken out in control group were significantly increased,as compared with those on admiting into operation room（ P 〈0. 05）,but hemoglobin and red cell volume were significantly decreased（ P〈 0. 05）. The incidence rate of adverse reactions was 9. 38% in observation group,which was 16. 13% in control group,there was no significant difference between two groups（ χ~2= 0. 5023,P 〉0. 05）. Conclusion The small-dose phenylephrine can keep heart rate and stabilize blood pressure in parturients receiving cesarean section with epidural anesthesia,which can decrease excessive fluid expansion due to hemodilution by colloid,with safety and few adverse side effects,thus,which is suitable for clinical application.