急诊剖宫产术中腰-硬联合麻醉下不同剂量去甲肾上腺素预防低血压效果

Effect of dfferent doses of norepinephrine for Preventing hypotension of women during emergency cesarean section under combined spinal-epidural anesthesia

目的:探讨不同剂量去甲肾上腺素预防腰-硬联合麻醉下急诊剖宫产术中低血压临床效果。方法:收集2017年6月-2020年6月本院采取腰-硬联合麻醉行急诊剖宫产手术产妇的临床资料,根据术中有无使用去甲肾上腺素及使用剂量分组,10μg组(n=45)麻醉后注射浓度为10μg/ml的去甲肾上腺素10μg, 15μg组(n=44)麻醉后注射浓度为10μg/ml的去甲肾上腺素15μg,未用组(n=51)不采用去甲肾上腺素,比较3组不同时点收缩压(SBP)、心率(HR)及手术中不良反应,新生儿Apgar评分和血气分析。结果:10μg组、15μg组、未用组腰麻后5 min、10 min、15 min、20 min时SBP、HR逐渐下降(P<0.05),但10μg组、15μg组10 min、15 min时下降幅度低于未用组(P<0.05)。低血压发生率10μg组(4.4%)与15μg组(4.6%)均低于未用组(17.7%)(P<0.05),恶心呕吐、心动过缓、寒战、胸闷发生率3组无差异(P>0.05)。新生儿1min、5min Apgar评分,及脐静脉血PH、PaO_(2)、PaCO_(2) 3组均无差异(P>0.05)。结论:在腰-硬联合麻醉下急诊剖宫产术中,使用去甲肾上腺素能有效预防低血压的发生,对新生儿影响小,推荐浓度为10μg/ml的去甲肾上腺素推荐使用剂量为10μg。

Obiective:To investigate the elinical efet of diferent doses of norepinephrine for preventing hypotension of women during emergency cesarean section under combined spina-epidural anesthesia.Methods:The elinical data of the women who had undergone emergency cesarean section under combined spinal epidural anesthesia from June 2017 to June 2020 were cllected retrospectively.The women were divided in group A(45 women with 10μg/mL norepineph-rine injection of 10μg),group B(44 women with 10g/mL norepinephrine injection of 15μg),and group C(51 women without norepinephrine injection)according to the used situation and the using dosage of norepinephrine.The values of systolic blood pressure(SBP)and heart rate(HR)at different time points.the incidence of adverse reactions during operation.the neonatal Apgar score,and the blood gas analysis results of the women were compared among the three groups.Results:The values of SBP and HR of the womenat 5 min.10 min.15 min and 20 min after combined spinal-epidural anesthesia in group A.in group B,and in group C had decreased gradually(P<0.05),but the decressing de-gree of which of the women in group A and in group Bat 10 min or 15 min after anestheaia was significantly lower than that of the women in group C(P<0.05).The incidence of hypotension of the women in group A(4.4%)or in group B(4.6%)was significantly lower than that(17.7%)of the women in group C(P<0.05).There were no significant differences in the incidences of nausea and vomiting.bradycardia.chills and chest distress of the women among the three groups(P>0.05).There were no signifcant differences in the neonatal Apgar scores at 1 min and 5 min after born.and the values of umbilical venous blood PH。PaO_(2)and PaCO_(2) of neonates among the three groups(P>0.05).Conclusion:Norepinephrine used during emergency cesarean section of the women under combined spinal-epidural an-esthesia can ffetively prevent the ocurrence of bhypotension,and which has lttle influence on their neonates.The rec-ommended dasge of 10μg/mL.norepinephrine is 10μg.