持续输注间羟胺对腰麻下剖宫产术中产妇血流动力学指标的影响

Effect of continuous metaraminol infusion on hemodynamics during spinal anesthesia for cesarean section

目的探讨持续输注间羟胺对腰麻下剖宫产术中产妇血流动力学指标的影响。方法选择嘉兴市妇幼保健院2019年9月至2020年3月单胎足月产妇80例,按随机数字表法分为间羟胺组和去氧肾上腺素组,每组40例。当鞘内注射时,间羟胺组预防性静脉输注间羟胺1.5μg/(kg·min),去氧肾上腺素组输注去氧肾上腺素0.5μg/(kg·min)。记录两组产妇麻醉前5min(T_(0))、鞘内注射5min后(T_(1))、切皮(T_(2))和胎儿娩出后即刻(T_(3))不同时点血流动力学指标参数[平均动脉压(MAP)、心率(HR)、心输出量(CO)及外周血管阻力(PVR)]、麻醉平面、鞘内注射至胎儿娩出时间、胎儿娩出后行脐动脉血气分析及评估新生儿Apgar评分。记录产妇和胎儿不良反应的发生情况(低血压、心动过缓、心动过速、恶心、呕吐及新生儿酸血症等)。结果鞘内注射后两组T_(1)时点MAP、HR及PVR与T_(0)时点比较均显著下降,差异均有统计学意义(均P<0.05);T_(1)时点两组MAP、HR、CO及PVR比较,差异均无统计学意义(均P>0.05);T_(2)、T_(3)时点间羟胺组MAP、HR、CO及PVR均高于去氧肾上腺素组,差异均有统计学意义(均P<0.05)。两组产妇恶心、呕吐、心动过缓、低血压、心动过速及新生儿酸血症发生率比较差异均无统计学意义(均P>0.05),但去氧肾上腺素组心动过缓发生率明显高于间羟胺组,差异有统计学意义(P<0.05)。结论与去氧肾上腺素比较,间羟胺能够增加腰麻下产妇MAP、HR、CO及PVR,降低心动过缓发生率,但不能降低术中低血压,恶心、呕吐发生率。

Objective To investigate the effect of continuous infusion of metaraminol on hemodynamic indexes of parturients during cesarean section under spinal anesthesia.Methods Eighty parturients who underwent cesarean section in Jiaxing Maternal and Child Health Hospital from September 2019 to March 2020 were randomly divided into two groups(n=40 in each group).When the intrathecal injection of spinal anesthesia started,the prophylactic intravenous infusion of 1.5μg/(kg·min)metaraminol(metaraminol group)or 0.5μg/(kg·min)phenylephrine(phenylephrine group)were given.The mean arterial pressure(MAP),heart rate(HR),cardiac output(CO)and peripheral vascular resistance(PVR),anesthesia level,time from intrathecal injection to fetal delivery,umbilical artery blood gas analysis,neonatal Apgar score were recorded,and the maternal and fetal adverse reactions were documented and compared between two groups.Results After intrathecal injection,MAP,HR and PVR at T_(1) in both groups were significantly lower than those at T_(0)(all P<0.05).There were no significant differences in MAP,HR,CO and PVR between the two groups at T_(1) time(all P>0.05).MAP,HR,PVR and CO in the metaraminol group were higher than those in the phenylephrine group at T_(2) and T_(3)(all P<0.05).There were no significant differences in the incidence of maternal nausea/vomiting,bradycardia,hypotension,tachycardia and neonatal acidemia between the two groups(all P>0.05),but the incidence of bradycardia in the phenylephrine group was significantly higher than that in the metaraminol group(P<0.05).Conclusion Compared with phenylephrine,metaraminol can increase the MAP,HR,CO and PVR of parturients under spinal anesthesia,and reduce the incidence of bradycardia,but can not reduce the incidence of intraoperative hypotension and nausea/vomiting.