不同剂量甲氧明预泵注对蛛网膜下腔阻滞麻醉下剖宫产产妇及新生儿的影响

发布时间：2018-01-11 00:22

本文关键词：不同剂量甲氧明预泵注对蛛网膜下腔阻滞麻醉下剖宫产产妇及新生儿的影响　出处：《中华实用诊断与治疗杂志》2016年04期 　论文类型：期刊论文

【摘要】：目的探讨不同剂量甲氧明预防性泵注对蛛网膜下腔阻滞麻醉剖宫产产妇血流动力学及新生儿的影响。方法择期蛛网膜下腔阻滞麻醉剖宫产孕妇80例,随机分为4组各20例。M1组、M2组、M3组术前分别将2、4、6mg甲氧明加入生理盐水配成20mL溶液,并于麻醉穿刺成功即刻以0.1、0.2、0.3mg/min速率泵注,对照组不泵注任何药物。记录4组产妇入室时(基础值)、麻醉后1、3min,胎儿娩出时,胎儿娩出后1、3min及术毕血压、心率变化,观察术中低血压、恶心呕吐、心动过缓等不良反应发生情况,记录新生儿Apgar评分及脐静脉血气指标。结果 M1组、M2组、M3组、对照组麻醉后1min时收缩压(systolic blood pressure,SBP)[(106.8±9.6)、(111.2±12.8)、(109.8±11.3)、(107.1±16.5)mm Hg]均较基础值[(119.8±7.8)、(121.5±8.9)、(116.8±8.9)、(123.4±8.1)mm Hg]下降(P0.01),M1组、M3组、对照组麻醉3min时SBP[(99.4±8.7)、(104.0±15.2)、(99.5±11.6)mm Hg]低于麻醉后1min(P0.05),M1组、M2组、M3组、对照组术毕SBP[(109.4±7.1)、(113.6±9.0)、(111.2±7.6)、(109.9±7.7)mm Hg]均低于基础值(P0.01);麻醉后1min,M1组、对照组心率较基础值增高(P0.01),M3组心率较基础值下降(P0.05),M2组心率与基础值比较差异无统计学意义(P0.05),胎儿娩出后1min,仅对照组心率较胎儿娩出时增高(P0.01);M1组、M2组分娩前低血压发生率(30%、15%)低于对照组(70%),M2组恶心呕吐发生率(5%)低于对照组(40%),M3组心动过缓发生率(40%)高于对照组(0),差异均有统计学意义(P0.05);4组新生儿Apgar评分以及脐静脉血pH、pa(O_2)、pa(CO_2)比较差异无统计学意义(P0.05)。结论术前以0.2mg/min速率泵注甲氧明可有效预防剖宫产患者麻醉后低血压,且血流动力学平稳,新生儿Apgar评分及脐静脉血气指标稳定。
[Abstract]:Objective to investigate the effects of different doses of methoxifen prophylaxis pump on hemodynamics of parturient and newborn in cesarean section under subarachnoid block anesthesia. Methods 80 pregnant women with selective subarachnoid block anesthesia were performed caesarean section. They were randomly divided into 4 groups (n = 20). M _ 2 group (n = 20), M _ 2 group (n = 20), M _ 2 group (n = 20) and M _ 3 group (n = 20). 0.2 mg / min pump was injected, while the control group was not injected with any drugs. 4 groups were recorded at the time of entering the room (basic value, 1 min after anesthesia, 1 min after delivery of fetus, 1 min after delivery), and 3 min after anaesthesia, 1 min after anaesthesia, 1 min after delivery of fetus and 1 min after delivery. The changes of blood pressure and heart rate at the end of operation were observed, and the adverse reactions such as hypotension, nausea and vomiting, bradycardia were observed, the Apgar score of newborn and the blood gas index of umbilical vein were recorded. Results M1 group. M 2 group M3, control group 1 min after anaesthesia, systolic systolic blood pressure (SBP). [106.8 卤9.6mHg, 111.2 卤12.8mHg, 109.8 卤11.3mHg, 107.1 卤16.5mm Hg, respectively. [119.8 卤7.8 + 121.5 卤8.9 mHg (116.8 卤8.9 mHg) decreased P0.01mHg in the M1 group. SBP in M3 group and control group during anaesthesia for 3 minutes. [The concentration of 99.4 卤8.7 MHg in 104.0 卤15.2mHg was lower than that in M3 group. SBP in control group. [The values of 109.4 卤7.1mHg and 113.6 卤9.0mm Hg were all lower than that of the base value (P 0.01). One minute after anesthesia, the heart rate of the control group was higher than that of the basic value, and the heart rate of the M3 group was lower than that of the base value (P0.05). There was no significant difference between heart rate and basic value in M2 group (P 0.05). The heart rate in the control group was higher than that in the control group at 1 min after delivery. The incidence of hypotension in M _ 1 group was lower than that in M _ 2 group (P < 0.05). The incidence of nausea and vomiting in M _ 2 group was lower than that in M _ 2 group (P < 0.05). The incidence of bradycardia in M3 group was higher than that in control group (P 0.05). The neonatal Apgar score and umbilical vein blood pH were evaluated in 4 groups. Conclusion 0.2 mg / min pump before operation can effectively prevent hypotension after anesthesia in patients with cesarean section. The hemodynamics was stable, Apgar score and umbilical vein blood gas index were stable.
【作者单位】：郑州大学人民医院河南省人民医院麻醉科;
【分类号】：R614
【正文快照】： 蛛网膜下腔阻滞麻醉起效快、效果确切,临床广泛用于剖宫产术,但低血压发生率高、程度严重,对产妇及胎儿均有不良影响[1]。甲氧明为一种高选择性α1受体激动剂,可通过单纯缩血管效应增高血压,在产科手术应用日益受到关注,但其静脉泵注方法及剂量目前尚未统一。本研究探讨不同剂

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