防御性应用去甲肾上腺素维持剖宫产术中血流动力学稳定的量效研究

A dose⁃effect study of defensive use of norepinephrine to maintain hemodynamic stability during cesarean section

目的探讨防御性输注去甲肾上腺素维持腰硬联合麻醉下剖宫产术中血流动力学稳定的量效关系。方法选取2020年1月—2021年4月行剖宫产术的100例产妇为研究对象,根据随机数字表法将其分为对照组(C组,不使用去甲肾上腺素)、NE0.025组[去甲肾上腺素0.025μg/(kg·min)]、NE0.05组[去甲肾上腺素0.05μg/(kg·min)]、NE0.075组[去甲肾上腺素0.075μg/(kg·min)]、NE0.10组[去甲肾上腺素0.10μg/(kg·min)],每组20例。麻醉药注射完成后,NE0.025组、NE0.05组、NE0.075组、NE0.10组分别持续输注去甲肾上腺素0.025μg/(kg·min)、0.05μg/(kg·min)、0.075μg/(kg·min)、0.10μg/(kg·min)。记录低血压、心动过缓、高血压、恶心、呕吐的发生情况。结果与C组比较,NE0.05组、NE0.075组、NE0.10组低血压、恶心、呕吐发生率较低,差异有统计学意义(P<0.05)。防御性输注去甲肾上腺素的半数有效药物剂量(ED50值)和95%有效药物剂量(ED95值)分别为0.042μg/(kg·min)和0.099μg/(kg·min)。Log⁃rank检验显示,不同麻醉剂量组的低血压发生率与未注射麻醉药的C组比较,差异有统计学意义(χ2=40.759,P<0.05)。结论防御性输注去甲肾上腺素维持腰硬联合麻醉下剖宫产术中的血流动力学稳定。

Objective To investigate the dose⁃effect of defensive infusion of norepinephrine to maintain hemodynamic stability during cesarean section under combined spinal epidural anesthesia.Methods A total of 100 pregnant women undergoing cesarean section from January 2020 to April 2021 were selected as study objects.They were divided into control group(group C,no norepinephrine was used),NE0.025 group[use of norepinephrine for 0.025μg/(kg·min)],NE0.05 group[use of norepi⁃nephrine for 0.025μg/(kg·min)],NE0.075 group[use of norepinephrine for 0.075μg/(kg·min)],NE0.10 group[use of norepinephrine for 0.10μg/(kg·min)]according to random number table method,with 20 cases in each group.After local anesthetic injection,NE0.025 group,NE0.05 group,NE0.075 group and NE0.10 group were continuously infused norepinephrine for 0.025μg/(kg·min),0.05μg/(kg·min),0.075μg/(kg·min)and 0.10μg/(kg·min),respectively.Occurrence of hypotension,bradycardia,hypertension,nausea and vomiting were recorded.Results Compared with group C,NE0.05,NE0.075 and NE0.10 groups had lower incidence of hypotension,nausea and vom⁃iting(P<0.05).The 50%effective doses(ED50)and effective doses(ED95)values of defensive norepinephrine infusion were 0.042μg/(kg·min)and 0.099μg/(kg·min),respectively.Log⁃rank test showed that the incidence rates of hypotension in different anesthetic dose groups showed significant differences compared with that in group C(χ2=40.759,P<0.05).Conclusion Defensive infusion of norepinephrine could maintain hemodynamic stability during cesarean section under com⁃bined epidural and lumbar anesthesia.