去氧肾上腺素不同给药方式对腰麻剖宫产产妇低血压及新生儿的影响

发布时间：2018-06-13 12:55

本文选题：去氧肾上腺素 + 腰麻　；参考：《皖南医学院》2017年硕士论文

【摘要】：目的:观察去氧肾上腺素三种不同给药方式对腰麻剖宫产术中产妇低血压及新生儿的影响。方法:选择择期腰麻剖宫产产妇120例,随机分为三组,每组40例。A组:鞘内注药后立即静脉注射5ml生理盐水组;B组:鞘内注药后立即静脉注射100μg去氧肾上腺素组;C组:鞘内注药后开始静脉泵注去氧肾上腺素25μg/min组。三组产妇腰麻前均预输注羟乙基淀粉10ml/kg,血压测量周期为每分钟一次。若连续两次测量的收缩压下降超过基础值20%,追加静脉注射去氧肾上腺素50μg,若心率低于60次/min,给予阿托品0.25mg,必要时重复。监测并记录产妇鞘内注药后20min内每分钟收缩压、心率;记录鞘Qg注药至胎儿取出这段时间内去氧肾上腺素和阿托品干预例数、次数以及去氧肾上腺素的总剂量;记录三组产妇出现反应性高血压、胸闷、恶心、呕吐的例数;记录三组新生儿1分钟、5分钟Apgar评分及脐带动、静脉血气值。结果:鞘内注药后前10min,C组产妇的收缩压、心率变化较A、B组更加平稳,A组的SBP第4min降至最低,与A组收缩压基础值(T_0)比较差异有统计学意义(P0.05),B组在第3min升至最高,第7min降至最低,与B组T_0比较差异有统计学意义(P0.05);A组心率在第3min升至最高,与A组心率基础值(T_0)比较差异有统计学意义(P0.05);C组需要追加去氧肾上腺素的例数及次数明显少于A、B组(P0.05),C组去氧肾上腺素总剂量明显高于A、B组(P0.05);与A组相比,B组去氧肾上腺素追加例数及次数较少(P0.05)。C组阿托品干预的例数明显低于A、B组(P0.05);C组有1例出现胸闷,未出现恶心、呕吐,与A组比较,C组胸闷及恶心的发生率更低(P0.05);A组有2例反应性高血压、B组有3例、C组未出现,三组比较差异无统计学意义(P0.05);三组新生儿1min、5min Apgar评分及脐带动、静脉血气值均在正常范围,三组比较差异无统计学意义(P0.05)。结论:1.去氧肾上腺素三种给药方式均能够纠正择期剖宫产产妇腰麻后低血压,并且对新生儿无不利影响。2.与间断静脉注射(A、B两组)比较,腰麻后持续静脉泵注去氧肾上腺素,产妇的血压、心率更加稳定,不良反应更少,且对新生儿无不利影响。
[Abstract]:Objective: to observe the effects of three different administration methods of noradrenaline on hypotension and newborn during cesarean section under spinal anesthesia. Methods: 120 cases of cesarean section with spinal anesthesia were randomly divided into three groups. Group A (n = 40): intrathecal injection of 5ml immediately after intrathecal injection. Group B: intravenous injection of 100 渭 g noradrenaline immediately after intrathecal injection. Group C: intravenous infusion of noradrenaline 25 渭 g/min after intrathecal injection. Hydroxyethyl starch was injected 10 ml / kg before spinal anaesthesia, and blood pressure was measured once a minute. If the systolic blood pressure drop of two consecutive measurements exceeds the base value of 20, add 50 渭 g of noradrenaline intravenously, if heart rate is less than 60 beats / min, give atropine 0.25 mg, repeat if necessary. Systolic blood pressure (SBP) and heart rate (HR) per minute in 20min were monitored and recorded after intrathecal injection, and the number, times and total dose of noradrenaline and atropine were recorded during the period between the administration of QG and fetuses. The cases of reactive hypertension, chest tightness, nausea and vomiting in the three groups were recorded, and the Apgar score of 1 minute and 5 minutes and the blood gas of umbilical artery and vein were recorded. Results: the systolic blood pressure (SBP) and heart rate (HR) of group C were more stable than those of group A (10 min after intrathecal injection), and the 4min of group A was lower than that of group A (P < 0.05). There was a significant difference between group A and group A (P < 0.05) in the 3min and the lowest in group A (P < 0.05). Compared with group B, there was significant difference in heart rate between group A and group B (P 0.05). The heart rate of group A rose to the highest in 3min. Compared with group A, the total dose of noradrenaline in group C was significantly lower than that in group A (P 0.05) and the total dose of noradrenaline in group C was significantly higher than that in group A (P 0.05), and the total dose of noradrenaline in group B was significantly higher than that in group A (P 0.05), and in group A, the total dose of noradrenaline in group B was significantly higher than that in group A (P 0.05), and that in group B was significantly higher than that in group A (P 0.05). The number and frequency of epinephrine supplementation was significantly lower in group C than that in group A B (P 0.05) and the incidence of chest tightness in group C was significantly lower than that in group A (P 0.05), and the incidence of chest tightness in group C was significantly lower than that in group A (P 0.05). There was no nausea and vomiting. The incidence of chest tightness and nausea in group C was lower than that in group A. There were 2 cases of reactive hypertension in group A and 3 cases in group B without nausea and vomiting. There was no significant difference among the three groups (P 0.05). The venous blood gas values were in the normal range, and there was no significant difference among the three groups (P 0.05). Conclusion 1. All three methods of administration of norepinephrine can correct hypotension after spinal anesthesia in elective cesarean section women, and have no adverse effect on newborns. 2. Compared with the two groups, continuous intravenous infusion of noradrenaline after spinal anesthesia, the blood pressure and heart rate of parturient were more stable, the adverse reactions were less, and there was no adverse effect on the newborns.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

【参考文献】