小剂量去氧肾上腺素预防腰-硬联合麻醉剖宫产术中低血压效果评价

Effect of Low-Dose of Phenylephrine on Prevention of Hypotension During Cesarean Section Under Combined Spinal-Epidural Anesthesia

目的观察小剂量去氧肾上腺素在腰-硬联合麻醉下行剖宫产手术时预防低血压的效果。方法选取医院收治的足月剖宫产孕妇84例,随机分为2组,在行腰-硬联合麻醉后,对照组(n=41)根据需要给予麻黄素调整血压,观察组(n=43)预先给予小剂量去氧肾上腺素。比较两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)以及术毕时(T_5)的血流动力学指标。结果观察组产妇心率、平均动脉压、心输出量在T_2,T_3,T_4时间点差值变化明显较对照组小(P<0.05);两组产妇术中不良反应发生率及新生儿Apgar评分比较,差异无统计学意义(P>0.05)。结论在腰-硬联合麻醉剖宫产手术中预防性应用小剂量去氧肾上腺素,能较好地维持产妇术中血流动力学稳定,药品相关不良反应少,且对新生儿Apgar评分无不良影响,值得临床推广。

Objective To observe the effect of low-dose phenylephrine on prevention of hypotension during cesarean section under combined spinal-epidural anesthesia. Methods Totally 84 term pregnant women undergoing cesarean section admitted to our hospital were selected and randomly divided into two groups. After the combined spinal-epidural anesthesia,the control group（n = 41） was given ephedrine if necessary to adjust the blood pressure,the observation group（n = 43） was given low-dose phenylephrine in advance. The hemodynamic indexes of parturients between the two groups were compared when they were in the quiet state（T1）,at 10 min after anesthesia（T2）,and at the time of skin incision（T3）,fetus removal（T4） and end of surgery（T5）. Results The difference value of heart rate（HR）,mean arterial pressure（MAP） and cardiac output（CO） in the observation group were significantly smaller than those in the control group at T2,T3 and T4（P〈0. 05）. There was no significant difference in the incidence rate of adverse reactions in maternal surgery and the score of neonatal Apgar between the two groups（P〉0. 05）. Conclusion Preventive application of low-dose phenylephrine in the cesarean section under combined spinal-epidural anesthesia can better maintain maternal hemodynamics stability during operation with less drug-related adverse reactions,it has no adverse effect on neonatal Apgar score,which is worthy of clinical promotion.