肾上腺素与去氧肾上腺素对剖宫产母儿血流动力学的影响

Effects of adrenaline and phenylephrine on mother and fetus hemodynamics undergoing caesarean section

目的通过与去氧肾上腺素的比较,探讨预防性输注肾上腺素对产妇及胎儿血流动力学的影响。方法选择上海交通大学医学院附属国际和平妇幼保健院择期行剖宫产术的初产妇作为研究对象,随机分为观察组和对照组。2组产妇开始鞘内注射局麻药时,观察组和对照组分别持续静脉输注肾上腺素和去氧肾上腺素,胎儿娩出后,同时采集脐动脉血样行血气分析,观察母儿血流动力学指标。结果与对照组相比,观察组产妇切皮和胎儿娩出后即刻的血压、心率、心输出量及每搏出量均高于对照组,但外周血管阻力低于对照组,2组间差异有统计学意义(P<0.05)。同时,观察组无产妇心动过缓和胎儿窘迫发生,而对照组则有5例产妇心动过缓,2例胎儿窘迫发生。结论肾上腺素和去氧肾上腺素均可有效预防剖宫产术所致的产妇低血压,并减少恶心呕吐等并发症的发生,但在产妇心动过缓和胎儿窘迫发生率方面,较去氧肾上腺素相比,使用肾上腺素更有优势。

Objective This study was designed to investigate the effects of prophylactic infusion of adrenaline on mother and fetus hemodynamics undergoing caesarean section.Methods Eighty full-term parturient women undergoing elective cesarean delivery under combined spinal-epidural anesthesia in international peace maternal and child health hospital were randomly divided into two groups(n=40):observation group and control group.They received prophylactic infusion of either phenylephfine or adrenaline after anesthesia began.After the delivery of the fetus,blood samples of umbilical artery were collected for blood gas analysis.Results Compared with the control group,the BP,HR,CO and SV values in the T2 and T3 time points in observation group were higher than in the control group,but the SVR was lower in the control group.There were significant differences between the two groups.The incidence of bradycardia was lower in observation group.There were significant differences between the two groups.There were two cases of fetal distress in uterine in the control group,but there was no fetal distress in uterine in observation group.There were significant differences in the pH value of umbilical artery between two groups(P<0.05).Conclusion Adrenaline and phenylephrine can effectively prevent maternal hypotension caused by cesarean section and reduce the occurrence of complications such as nausea and vomiting,however,the use of adrenaline is more advantageous than phenylephrine in terms of maternal and fetal heart rate and the pH value of the umbilical artery.