上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (8): 1143-.doi: 10.3969/j.issn.1674-8115.2017.08.018

• 论著（临床研究） • 上一篇    下一篇

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#br#

杨世科，陈杰，刘敏，王涛，孙文群，李莉，毛德志   

  1. 上海中冶医院麻醉科，上海 200941
  • 出版日期:2017-08-28 发布日期:2017-09-28
  • 通讯作者: 毛德志，电子信箱：dzmaosh@gmail.com
  • 作者简介:杨世科（1984—），男，主治医师，硕士；电子信箱：shikey001@163.com

Effect of prophylactic phenylephrine in parturients prone to develop spinal hypotension#br#

YANG Shi-ke, CHEN Jie, LIU Min, WANG Tao, SUN Wen-qun, LI Li, MAO De-zhi   

  1. Department of Anesthesiology, Shanghai Zhongye Hospital, Shanghai 200941, China
  • Online:2017-08-28 Published:2017-09-28

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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 8 mmHg（1 mmHg=0.133 kPa）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 8 mmHg 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 50 µg 后，给予 50 µg/min 泵注，10 min 后改为 25 µg/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 1 min 和 5 min 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 P<0.01）。 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1 min 和 5 min 的 Apgar 评分组间比较，差异均无统计学意义（均P>0.05）。 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。

关键词: 剖宫产术, 腰 - 硬联合阻滞, 脊椎麻醉后低血压, 反应性高血压, 去氧肾上腺素

Abstract:

Objective · To evaluate the efficacy and safety of prophylactic phenylephrine in parturients prone to develop spinal hypotension.  Methods · Fifty parturients undergoing elective cesarean delivery whose preoperative positional mean arterial pressure (MAP) change from supine to right lateral position were bigger than 8 mmHg (1 mmHg=0.133 kPa) were randomly allocated into 2 groups, i.e. high-risk prevented group (group A) and high-risk control group (group B). Another 25 parturients whose positional MAP change were smaller than 8 mmHg were allocated into low-risk prevented group (group C). After spinal anesthesia, phenylephrine (50 µg bolus and 50 µg/min infusion) was given immediately to group A and C, and the pump speed was adjusted to 25 µg/min 10 min later till fetuses were removed. Normal saline with the  same volume and pump speed was given to group B. The incidences of hypotension, reactive hypertension, and bradycardia, the occurrence of nausea and vomiting, and Apgar scores at 1 min and 5 min of three groups were compared.  Results · The incidence of hypotension in group A was 28%, 76% in group B, and 16% in group C. Group A and C were significantly lower than group B (P<0.01). The reactive hypertension rate was 4% in group A and 28% in group C. There was a difference between these two group (P=0.015). There were no significant differences among 3 groups in Apgar scores at 1 min and 5 min (P>0.05).  Conclusion · Prophylactic phenylephrine in the paturients prone to develop spinal hypotension reduces the incidence of spinal hypotension without obvious adverse effects on the paturients and neonates.

Key words:  cesarean delivery, spinal-epidural combination anesthesia, spinal hypotension, reactive hypertension, phenylephrine