不同剂量甲氧明在剖宫产腰硬联合麻醉中应用分析

Analysis effect of different dosage of methoxamine in spinal combined with epidural anesthesia of cesarean section

目的:探讨不同剂量甲氧明在剖宫产术中麻醉效果。方法:选取2014年12月-2017年12月本院行剖宫产术的产妇136例为观察对象,随机分为4组。3组麻醉成功后分别将2mg、4mg、6mg甲氧明于以0.1、0.2、0.3mg/min泵注,空白组泵注等量生理盐水。记录4组产妇入室平静时、麻醉平卧位即刻、平卧后1min、5min、胎儿娩出前1min、娩出后5min的收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO2),观察术中不良反应发生情况,记录新生儿动脉血气分析指标及娩出后Apgar评分。结果:4组产妇T1、T2、T5时的SBP均较T0时降低,3个甲氧明用药组T3时的SBP均较T2时降低(均P<0.05);2mg组、空白组T1时的HR较T0时增高,6mg组较T0时降低(均P<0.05),而4mg组较T0时比较无差异(P>0.05);甲氧明3个组低血压发生率低于空白组,4mg组恶心发生率低于空白组,6mg组心动过缓发生率高于空白组(均P<0.05);4组新生儿出生后的1min、5min Apgar评分及血气分析指标对比无差异(P>0.05)。结论:麻醉成功后采取4mg甲氧明以0.2mg/min泵注,可有效预防低血压发生,产妇血流动力学波动更为平稳。

Objective To explore the effect of different dosage of methoxamine in spinal combined with epidural anesthesia of cesarean section. Methods： 136 pregnant women wanted delivery by cesarean section were randomly divided into group A, group B, group C, and group D （34 cases in each group）. The women in group A, group B, group C were given 2, 4 and 6 mg methoxamine,repectively （methoxamine added into 20 mL normal saline, and were infused at the speeds of 0.1, 0.2 and 0.3 mg/min immediately after lumbar puncture success）. The women in group D were infused 20ml physiological saline. The systolic blood pressures （SBP）, diastolic blood pressures （DBP）, heart rate （HR）, and pulse oxygen saturation （SPO2） of all women were recorded when entered the operating room, 1 and 5 min after spinal anesthesia, 1 min before delivery, and 5 min after delivery. The incidences of adverse reactions of women included hypotension, nausea and vomiting, and bradycardia were observed during operation. The neonatal Apgar score and umbilical vein blood gas indexes were recorded. Results： SBP of all women in the four groups in T1, T2 and T5 were significant lower than those in T0 （ P 〈0.05）. SBP of women in group A, B and C in T3 were significant lower than those in T2 （ P 〈0.05）. HR of women in group A and D in T1 were significant higher than those in T0 （ P 〈 0.05 ）, and HR of women in group C in T1 were significant lower than that in T0 （ P 〈0.05）, but there was no significant different in HR between T1 and T0 （ P 〉0.05）. The incidence of hypotension of women in group A, group B, or group C was significant lower than those of women in group D （ P 〈0.05）. The incidence of nausea of women in group B was significant lower than those of women in group D （ P 〈0.05）. The incidence of bradycardia of women in group C was significant higher than that of women in group D （ P 〈0.05）. There was no significant different in blood gas indexes and Apgar score of newborns at 1, 5 min after born among the four groups （ P 〉0.05）. Conclusion： Prophylactic methoxamine infused by micro pump at the speed of 0.2 mg/min after spinal anesthesia during cesarean section is effective for preventing hypotension, and can make maternal hemodynamic fluctuations more stable.