小剂量甲氧明对剖宫产麻醉产妇血流动力学和新生儿血气的影响

Effect of small dose methoxamine on parturient′s hemodynamics and neonatal blood gas during anesthesia of cesarean section

目的探讨小剂量甲氧明对剖宫产手术麻醉中产妇血流动力学和新生儿的影响。方法选取2014年1月至2016年6月间在该院行剖宫产术实施腰-硬联合麻醉产妇285例,分3组,A组麻醉完成后即刻静脉注射盐酸甲氧明1mg,B组注射2mg,C组静脉注射生理盐水2mL,记录入室平静后基础值(T0)、麻醉平卧位即刻(T_1)、麻醉平卧后1min(T_2)、麻醉平卧后5min(T_3)、胎儿娩出前1min(T4)、胎儿娩出后5min(T5)各时间点产妇的收缩压(SBP)、心率(HR)变化情况,新生儿脐动脉血pH、血气指标[氧分压(PO_2),二氧化碳分压(PCO_2)]及出生1min Apgar评分,观察产妇术中出现恶心、呕吐等不良反应情况。结果 B组及C组产妇在T_2时刻HR明显升高后又明显降低(P<0.05),而A组产妇在T_1时刻开始降低后,在T_2~T4各时间点HR均明显低于B组及C组,且无较大波动(P<0.05);3组产妇的SBP自T_2时刻起均较T0时刻明显降低(P<0.05),但在T_2~T4各时间点A组产妇的SBP均明显高于B组及C组(P<0.05);A、B组新生儿脐动脉血pH、血气指标及出生1min后Apgar评分组间差异均无统计学意义(P>0.05),但C组新生儿脐动脉血pH、出生1min后Apgar评分均明显低于A、B组(P<0.05);A组产妇的不良反应率为2.11%,明显低于B组(9.47)%及C组(13.68)%,差异有统计学意义(P<0.05)。结论小剂量甲氧明能够有效维持剖宫产术腰硬联合麻醉后产妇血流动力学平稳,对新生儿无不良影响。

Objective To investigate the effect of small dose methoxamine on parturient′s circulation stability and neonate during anesthesia of cesarean section.Methods Two hundreds and eighty-five cases of cesarean section under combined spinal epidural anesthesia in the hospital from January 2014 to June 2016 were selected and divided into 3 groups.The group A was intravenously injected by 1 mg of methoxamine hydrochloride instantly after anesthesia,the group B by 2 mg,while the group C was intravenously injected by 2 mL of normal saline.The basic values at calmness after entering the operation room(T_0),systolic blood pressure(SBP)and heart rate(HR)at horizontal position immediately after anesthesia(T_1),at 1 min(T_2),5 min(T_3)after anesthesia,at 1 min(T_4)before fetus delivery and at 5 min after fetus delivery(T_5)were recorded,and neonatal umbilical arterial blood pH value,blood gas indicators and Apgar score at 1 min after delivery were also recorded.The parturient appearing the adverse reactions such as nausea and vomiting during operation were observed.Results HR at T_2 in the group B and C was significantly increased,then decreased significantly(P<0.05),while which at T_1 in the group A began to decrease and HR at the various time points of T_2-T_4 were significantly lower than those in the group B and C,moreover had no big fluctuation(P<0.05);SBP at T_2 in 3 groups was significantly decreased compared with that at T0(P<0.05),but SBP at the various time points of T_2-T_4 in the group A were significantly higher than those in the group B and C(P<0.05);umbilical vein blood pH,blood gas indexes and Apgar score at 1 min after birth had no statistically significant differences between the group A and B(P>0.05),but which in the group C were significantly lower than those in the group A and B(P<0.05);the adverse reaction rate in the group A was 2.11%,which was significantly lower than 9.47%in the group B and 13.68%in the group C(P<0.05).Conclusion Small dose of methoxamine can effectively maintain the parturient′s hemodynamic stability after combined spinal epidural anesthesia in cesarean section and has no adverse effect on neonate.