不同液体预输注联合盐酸去氧肾上腺素对剖宫产产妇及新生儿的影响

Effect of preloading different kinds of liquid combined with phenylephrine on parturient and neonate during epidural anesthesia for cesarean section

目的观察预输注不同种类液体联合盐酸去氧肾上腺素对剖宫产产妇及新生儿的影响。方法择期行剖宫产术产妇60例，用随机数字表法分为两组（每组30例）：6％羟乙基淀粉130／0．4氯化钠注射液500ml组（H组）和乳酸钠林格注射液1000ml组（R组）。麻醉前进行液体预输注。硬膜外穿刺成功后均立即静脉泵注盐酸去氧肾上腺素0．5μg·kg^-1·min^-1，取出胎儿后停止输注。记录产妇入室后（T0）、注药后3min（T1）、注药后10min（T2）、胎儿取出后3min（T3）、胎儿取出后10min（T4）时的HR、SBP和DBP，记录产妇围手术期副作用发生情况及新生儿1min、5minApgar评分，记录胎儿在取出时的脐静脉血气检查结果。结果T4时H组产妇HR低于R组，T2时H组产妇SBP高于R组，差异有统计学意义（P〈0．05）。与T0时比较：H组产妇T1、T2、T4时HR降低，T1、T2时SBP降低，T1～T4时DBP降低；R组产妇T2、T4时SBP降低，T2～T4时DBP降低；差异均有统计学意义（P〈0．05）。两组新生儿血气分析比较，H组血乳酸浓度低于R组，血糖值则高于R组，差异有统计学意义（P〈0．05）。两组产妇恶心呕吐、头晕、胸闷的发生率差异无统计学意义（P〉0．05）。两组新生儿1min、5minApgar评分差异无统计学意义（P〉0．05）。结论择期剖宫产术中产妇应用胶体液联合盐酸去氧肾上腺素泵注较晶体液可能具有更稳定的血流动力学环境，对新生儿影响更小。

Objective To investigate the effect of preloading different kinds of liquid combined with phenylephrine on parturients and neonate during epidural anesthesia for cesarean section. Methods Sixty patients who were eligible to cesarean section were randomly divided into two groups（n=30）： hydroxyethyl starch（6% in normal saline） 500 ml（group H） and lactated ringers solution 1 000 ml（group R）. All patients were treated with a phenylephrine infusion 0.5μg·kg^-1·min^-1. Phenylephrine infusion protocol was continued until the time of fetal extraction. Recorded the HR, SBP and DBP at beginning of anesthesia（T0）, 3 min（T1）, 10 rain（T2） before cesarean section, 3 min（T3）, 10 min（T4） after delivery the fetus. The maternal perioperative adverse events of parturients and the Apgar score of the newborn at 1, 5 min were recorded after fetal delivery. At the same time, umbilical vein blood gas analysis results of the fetus after delivery was also recorded. Results Compared with group R, HR was significantly decreased at T4 in group H. Compared with group H, SBP at T2 group R decreased significantly（P〈0.05）. HR in group H at T1, T2, T4 were lower than HR in group R. SBP values in group H decreased at T1, T2 while SBP values in group R decreased at T2, T4, DBP values in group H decreased at T1-T4 while DBP values in group R decreased at T2-T4. Fetal umbilical venous blood lactate values of group R were significantly higher than values in group H（P〈0.05）. Fetal umbilical vein blood glucose values of group H were higher than values of group R（P〈 0.05）. Apgar scores between the two groups at 1 min and 5 min are not significantly different（P〉0.05 ）. Rates of nausea and vomiting, dizziness, chest tightness are not significant different between the two groups（P〉0.05）. Conclusions Preloading with 6% of hydroxyethyl starch before cesarean section was beneficial to getting more stable hemodynamics and less negative effect on newborn baby.