去甲肾上腺素不同泵注速率对腰硬联合麻醉下剖宫产母婴的影响

Effect of different pump rate of norepinephrine on maternal and neonatal of cesarean section under combine spinal-epidural anaesthesia

目的探讨去甲肾上腺素(NE)不同泵注速率对腰硬联合麻醉下剖宫产母婴的影响。方法选择我院2016年10月至2017年9月收治的剖宫产产妇132例为研究对象,随机分为对照组、NE_1组、NE_2组和NE_3组,每组33例。对照组根据产妇实际情况,补救性单次注射NE。NE_1组、NE_2组和NE_3组均给予去甲肾上腺持续泵入,速率分别为0.03、0.04、0.05μg/(kg·min)。对比四组产妇低血压、高血压及恶心呕吐发生率,新生儿出生后1、5 min Apgar评分。结果与NE_1组、NE_2组和NE_3组比较,对照组产妇的低血压及恶心呕吐发生率明显更高(P<0.05);与NE_1组和NE_2组比较,NE_3组产妇的低血压发生率明显更高(P<0.05);NE_3组产妇高血压发生率高于对照组、NE_1组、NE_2组(P<0.05)。四组新生儿出生后1、5 min Apgar评分比较,差异无统计学意义(P>0.05)。结论在剖宫产腰硬联合麻醉中,NE持续泵入优于单次补救给药,对母婴影响较小,其中0.04μg/(kg·min)泵注速率较为理想。

Objective To investigate the effect of different pumping rates of norepinephrine （NE） on maternal andneonatal of cesarean section under combine spinal-epidural anaesthesia. Methods From October 2016 to September 2017,132 cases of cesarean section women in our hospital were selected as the study objects and randomly divided into controlgroup, NE1 group, NE2 group and NE3 group, with 33 cases in each group. The control group received a single injection ofNE according to the actual condition of the pregnant women. The NE1 group, the NE2 group and the NE3 group were givencontinuous NE infusion at the rates of 0.03, 0.04, 0.05 滋g/（kg· min）, respectively. The incidences of hypotension,hypertension, nausea and vomiting of maternal, the Apgar scores of neonatal at 1 and 5 min after birth were comparedamong the four groups. Results Compared with the NE1 group, the NE2 group and the NE3 group, the incidences ofhypotension, nausea and vomiting in the control group were significantly higher（P〈0.05）. Compared with the NE1 group andthe NE2 group, the incidence of hypotension in the NE3 group was significantly higher （P〈0.05）. The incidence ofhypertension in the NE3 group was higher than those in the control group, the NE1 group and the NE2 group（P〈0.05）. Therewere no significant differences in the Apgar scores of neonatal at 1 and5 min after birth among the four groups （P〉0.05）.Conclusion In cesarean section under combine spinal-epidural anaesthesia, continuous NE pumping is better than a singleremedy, with little effect on maternal and child, of which, 0.04 滋g/（kg min） pump rate is ideal.