高渗氯化钠羟乙基淀粉复合麻黄碱在蛛网膜下腔联合硬膜外腔阻滞麻醉剖宫产中对产妇和新生儿的影响

发布时间：2018-04-13 09:26

本文选题：蛛网膜下腔联合硬膜外腔阻滞麻醉 + 剖宫产术　；参考：《广西医学》2016年05期

【摘要】：目的探讨静脉预注射高渗氯化钠羟乙基淀粉复合麻黄碱在蛛网膜下腔联合硬膜外腔阻滞麻醉剖宫产中对产妇和新生儿的影响。方法足月妊娠行蛛网膜下腔联合硬膜外腔阻滞麻醉剖宫产术的产妇120例,分为A组、B组、C组,每组40例。A组麻醉前静脉滴注高渗氯化钠羟乙基淀粉,B组、C组静脉滴注乳酸钠林格液;A组、B组在蛛网膜下腔阻滞麻醉开始注射药物的同时静脉注射麻黄碱,术中均用乳酸钠林格液维持。监测3组产妇麻醉前(T_1)、注射麻醉药物后1 min(T_2)、3 min(T_3)、5 min(T_4)、15 min(T_5)、30 min(T_6)的收缩压及心率。并监测新生儿出生时脐静脉血p H、Pa CO_2、Pa O_2、碱剩余(BE),评估出生后1 min、5 min Apgar评分、HR。结果 3组的收缩压及心率比较,差异有统计学意义(P0.05),各组的收缩压及心率有随时间变化的趋势(P0.05),其中A组产妇的收缩压变化幅度小;B组产妇的收缩压在麻醉后前半程较平稳,但是在麻醉15 min(T_5)后出现明显下降趋势,C组产妇的收缩压在麻醉后即开始出现剧烈下降;3产妇的心率在整个过程的变化幅度均小。A组无在麻醉后及术中发生剧烈血压下降而需要使用麻黄碱的病例,B、C组使用麻黄碱的产妇比例均显著高于A组(P0.05)。A组新生儿脐静脉血p H、Pa O_2、BE值及生后1 min Apgar评分均高于B、C组(P0.05)。结论静脉预注高渗氯化钠羟乙基淀粉和麻黄碱对剖宫产术中产妇的低血压有防治作用,且有利于维持胎儿酸碱平衡稳定和提供足够氧供。
[Abstract]:Objective to investigate the effect of preinjection of hypertonic sodium chloride hydroxyethyl starch and ephedrine on parturient and newborn during cesarean section under subarachnoid and epidural block anesthesia.Methods 120 pregnant women undergoing subarachnoid and epidural block cesarean section were divided into group A (group B) and group C (group C).Each group (40 cases) received intravenous drip of hypertonic sodium chloride hydroxyethyl starch before anesthesia (group B) and group C (group C) received sodium lactate and Ringer solution intravenously (group A). Group B received ephedrine intravenously during subarachnoid block anesthesia at the same time as injection of ephedrine.All patients were maintained with sodium lactate Ringer's solution during operation.The systolic blood pressure (SBP) and heart rate (T6) were monitored before anesthesia, 1 min after injection of anesthetic, 1 min, 3 min, 3 min, 3 min, 3 min, 5 min, T 4, 15 min, T 5 min, 30 min T 6).The umbilical vein blood of neonates at birth was monitored for navel vein blood p HG Pa CO 2P O 2, alkali-residual tibia, and 1 minute postnatal 5 min Apgar score was evaluated. The results were as follows: 1 min after birth, 5 min Apgar scores were evaluated.But after 15 min of anesthesia, there was a significant downward trend in systolic blood pressure (SBP) of parturient in group C, which began to decrease sharply after anesthesia. The heart rate of parturient in group A was small in the whole process. There was no severe blood flow in group A after anesthesia and during operation.Conclusion preinjection of hypertonic sodium chloride hydroxyethyl starch and ephedrine can prevent and cure hypotension of parturient during cesarean section, and it is helpful to maintain the stability of fetal acid-base balance and provide adequate oxygen supply.
【作者单位】：广西医科大学附属民族医院麻醉科;
【分类号】：R614

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