脊椎麻醉后低血压高危产妇预防性使用去氧肾上腺素效果的研究

发布时间：2018-04-17 06:26

本文选题：剖宫产术 + 腰-硬联合阻滞　；参考：《上海交通大学学报(医学版)》2017年08期

【摘要】：目的·评价对于脊椎麻醉后低血压高危产妇预防性使用去氧肾上腺素的效果和安全性。方法·选择麻醉前仰卧位与右侧卧位平均动脉压(MAP)差值大于8mmHg(1mmHg=0.133kPa)行择期剖宫产术的产妇50例,随机分为高危预防组(A组)和高危对照组(B组),再选取MAP差值小于8mmHg的产妇25例为低危预防组(C组)。脊椎麻醉完成后,A组和C组立即静脉注射去氧肾上腺素50μg后,给予50μg/min泵注,10min后改为25μg/min直至胎儿取出;B组给予同等容量和泵注速度的生理盐水。比较3组产妇麻醉后低血压、反应性高血压、恶心呕吐、心动过缓发生率,新生儿出生后1min和5min的Apgar评分。结果·3组产妇脊椎麻醉后低血压发生率分别为28%、76%和16%,A组、C组显著低于B组(均P0.01)。A组与C组反应性高血压发生率分别为4%和28%,差异有统计学意义(P=0.015)。新生儿出生后1min和5min的Apgar评分组间比较,差异均无统计学意义(均P0.05)。结论·针对脊椎麻醉后低血压高危产妇预防性使用去氧肾上腺素能明显降低脊椎麻醉后低血压的发生,且无明显不良反应,对新生儿Apgar评分无影响。
[Abstract]:Objective to evaluate the efficacy and safety of prophylactic use of noradrenaline in high risk women with hypotension after spinal anesthesia.Methods 50 parturients undergoing elective cesarean section were selected for elective cesarean section in supine position and right lateral position.They were randomly divided into high risk prevention group (group A) and high risk control group (group B). 25 cases of parturient whose MAP difference value was less than 8mmHg were selected as low risk prevention group (group C).After spinal anesthesia was completed, 50 渭 g of noradrenaline was injected intravenously in group A and group C, then injected with 50 渭 g/min pump for 10 minutes and then changed to 25 渭 g/min until fetuses were taken out of group B to receive saline of the same volume and velocity.The incidence of hypotension, reactive hypertension, nausea and vomiting, bradycardia, postnatal 1min and 5min were compared among the 3 groups.Results the incidence of hypotension in group A was significantly lower than that in group B (P 0.01). The incidence of reactive hypertension was 4% in group A and 28% in group C, respectively. The difference was statistically significant.There was no significant difference in the Apgar scores of 1min and 5min between the newborns after birth (P 0.05).Conclusion prophylactic use of norepinephrine in high risk women with hypotension after spinal anesthesia can significantly reduce the incidence of hypotension after spinal anesthesia and has no significant adverse effects on neonatal Apgar score.
【作者单位】：上海中冶医院麻醉科;
【分类号】：R614

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