麻黄素与去氧肾上腺素预防蛛网膜下腔硬膜外联合麻醉下剖宫产术中低血压的效果

Preventive effects of ephedrine and phenylephrine on hypotension during cesarean section under combined spinal-epidural anesthesia

目的观察麻黄素与去氧肾上腺素预防蛛网膜下腔硬膜外联合麻醉(CSEA)下剖宫产术中低血压的效果。方法选取2015年2月至2016年10月在河北省优抚医院行剖宫产术的孕足月产妇87例,根据随机数字表法分为麻黄素组(44例)和去氧肾组(43例)。均采用CSEA,麻黄素组产妇在麻醉后预先静脉给予10 mg麻黄素预防低血压;去氧肾组麻醉后给予100μg去氧肾上腺素进行预防。比较2组产妇在安静状态时(T_1)、麻醉后10 min(T_2)、切皮时(T_3)、胎儿取出时(T_4)、术毕时(T_5)的血流动力学指标,术中及术后的不良反应发生情况,以及新生儿血气分析指标和Apgar评分。结果 2组产妇T_2、T_3、T_4、T_5时心率、平均动脉压、心输出量与T,时的差值比较,差异均无统计学意义(均P>0.05)。去氧肾组发生术中恶心呕吐2例,麻黄素组发生术中恶心呕吐2例、术后寒战1例,2组不良反应发生率比较差异无统计学意义(P>0.05)。去氧肾组新生儿pH值、HCO_3^-、剩余碱高于麻黄素组[(7.41±0.03)比(7.37±0.12)、(25.5±0.6)mmol/L比(24.8±0.8)mmol/L、(0.42±0.19)mmol/L比(-1.32±0.71)mmol/L],差异均有统计学意义(均P<0.05)。2组新生儿Apgar评分比较,差异无统计学意义(P>0.05)。结论 CSEA预防性应用麻黄素和小剂量去氧肾上腺素均能够较好地维持产妇术中血流动力学稳定,药物相关不良反应少,而且对于新生儿Apgar评分无不良影响。但与麻黄素相比,小剂量去氧肾上腺素能更好地维持新生儿机体酸碱平衡,不会引起新生儿代谢增加。

Objective To observe the effects of ephedrine and phenylephrine in prevention of hypotension during cesarean section under combined spinal-epidural anesthesia（CSEA）. Methods A total of 87 pregnant women undergoing cesarean section from February 2015 to October 2016 in Youfu Hospital of Hebei Province were randomly divided into ephedrine group（n＝44） having intravenous injection of 10 mg ephedrine and phenylephrine group（n＝43） having intravenous injection of 100 μg phenylephrine before CSEA. Hemodynamic parameters were recorded in quiet state before operation, 10 min after anesthesia, during skin incision, during fetal removal and at the end of operation. Adverse reactions were observed during and after operation. Blood gas parameters and the Apgar score of neonates were analyzed. Results Changes of heart rate, mean arterial pressure and cardiac output showed no significant differences between groups at different time points（P＞0.05）. There were respectively 2 cases of nausea and vomiting during operation in phenylephrine group and ephedrine group; there was 1 case of shivering after operation in ephedrine group; the incidence rate of adverse reactions had no significant difference between groups（P＞0.05）. The pH value, HCO-3 and base excess of neonates in phenylephrine group were significantly higher than those in ephedrine group［（7.41±0.03） vs （7.37±0.12）, （25.5±0.6）mmol/L vs （24.8±0.8）mmol/L, （0.42±0.19）mmol/L vs （－1.32±0.71）mmol/L］（P＜0.05）. The Apgar score of neonates showed no significant difference between groups（P＞0.05）. Conclusions Both prophylactic application of ephedrine and low dose phenylephrine after CSEA can maintain hemodynamic stability with few adverse reactions and have no adverse effect on neonatal Apgar score. Phenylephrine can maintain the acid-base balance of neonates better than ephedrine.