麻黄素、去氧肾上腺素和去甲肾上腺素预防剖宫产手术腰麻后低血压的效果及对新生儿影响的比较
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摘要
目的:研究麻黄素、去氧肾上腺素和去甲肾上腺素预防剖宫产手术腰麻后低血压的效果及对新生儿影响比较。方法:选择本院125例剖宫产妇作为研究对象,根据其手术用药情况分为麻黄素组40例、去氧肾上腺素组45例、去甲肾上腺素组40例。比较3组不同时段的生命体征、新生儿血气分析、新生儿Apgar评分、不良反应。结果:3组T_0～T_3的HR比较,T_0、T_1的SBP、DBP比较,差异均无统计学意义(P>0.05);麻黄素组T_3的HR、SBP、DBP显著高于去氧肾上腺素组,并显著低于去甲肾上腺素组,差异均有统计学意义(P<0.05)。麻黄素组的PCO_2、PO_2与去氧肾上腺素组、去甲肾上腺素组比较,差异均无统计学意义(P>0.05);麻黄素组的pH显著高于去氧肾上腺素组,并显著低于去甲肾上腺素组,差异均有统计学意义(P<0.05);麻黄素组的SpO_2显著低于去氧肾上腺素组,并显著高于去甲肾上腺素组,差异均有统计学意义(P<0.05)。麻黄素组、去甲肾上腺素组新生儿出生时的Apgar评分显著低于去氧肾上腺素组,差异均有统计学意义(P<0.05);3组新生儿出生后5min、出生后10min的Apgar评分比较,差异均无统计学意义(P>0.05)。3组的低血压、头痛、眩晕发生率比较,差异均无统计学意义(P>0.05);去氧肾上腺素组的高血压、胃肠道反应、多汗、心悸发生率显著低于去甲肾上腺素组,差异均有统计学意义(P<0.05)。结论:去氧肾上腺素对产妇及新生儿的安全性更高,且剖宫产手术腰麻后低血压的预防效果,与麻黄素、去甲肾上腺素比较无差异。
Objective:To study the effects of ephedrine,phenylephrine and norepinephrine prevent hypotension after spinal anesthesia in cesarean section and comparison of effects on newborns.Methods:A total of 125 cesarean section women in our hospital from December 2016 to January 2018 were selected as the study subjects.According to the drug used in surgery,which was divided into 40 cases of ephedrine group,45 cases of phenylephrine group and 40 cases of norepinephrine group.The vital signs,neonatal blood gas analysis,neonatal Apgar score,adverse reactions of the three groups were compared,Result:The HR of three groups of T_0-T_3 were compared,and there was no significant difference in SBP and DBP between T_0 and T_1(P>0.05).The HR,SBP and DBP of T_3 in the ephedrine group were significantly higher than those in the phenylephrine group,and significantly lower than the norepinephrine group(P<0.05).There were no significant differences in the PCO_2 and PO_2 between the ephedrine group and the phenylephrine group and the norepinephrine group(P>0.05).The pH of the ephedrine group was significantly higher than that of the phenylephrine group,and was significantly lower than that of the norepinephrine group(P<0.05).The SpO_2 in the ephedrine group was significantly lower than that in the phenylephrine group,and was significantly higher than the norepinephrine group(P<0.05).The Apgar scores of newborns in the ephedrine and norepinephrine groups were significantly lower than those in the phenylephrine group,and the differences were statistically significant(P<0.05).There were no significant differences in Apgar scores between the three groups of newborns 5 min after birth and10 min after birth(P>0.05).There were no significant differences in the incidence of hypotension,headache,and dizziness between the three groups(P>0.05).The incidence of hypertension,gastrointestinal reactions,hyperhidrosis,and palpitations in the phenylephrine group was significantly lower than that in the norepinephrine group,and the difference was statistically significant(P<0.05).Conclusion:The safety of phenylephrine is higher in maternal and neonatal,and the preventive effect of hypotension after spinal anesthesia in cesarean section is no different from ephedrine and norepinephrine.
Objective:To study the effects of ephedrine,phenylephrine and norepinephrine prevent hypotension after spinal anesthesia in cesarean section and comparison of effects on newborns.Methods:A total of 125 cesarean section women in our hospital from December 2016 to January 2018 were selected as the study subjects.According to the drug used in surgery,which was divided into 40 cases of ephedrine group,45 cases of phenylephrine group and 40 cases of norepinephrine group.The vital signs,neonatal blood gas analysis,neonatal Apgar score,adverse reactions of the three groups were compared,Result:The HR of three groups of T_0-T_3 were compared,and there was no significant difference in SBP and DBP between T_0 and T_1(P>0.05).The HR,SBP and DBP of T_3 in the ephedrine group were significantly higher than those in the phenylephrine group,and significantly lower than the norepinephrine group(P<0.05).There were no significant differences in the PCO_2 and PO_2 between the ephedrine group and the phenylephrine group and the norepinephrine group(P>0.05).The pH of the ephedrine group was significantly higher than that of the phenylephrine group,and was significantly lower than that of the norepinephrine group(P<0.05).The SpO_2 in the ephedrine group was significantly lower than that in the phenylephrine group,and was significantly higher than the norepinephrine group(P<0.05).The Apgar scores of newborns in the ephedrine and norepinephrine groups were significantly lower than those in the phenylephrine group,and the differences were statistically significant(P<0.05).There were no significant differences in Apgar scores between the three groups of newborns 5 min after birth and10 min after birth(P>0.05).There were no significant differences in the incidence of hypotension,headache,and dizziness between the three groups(P>0.05).The incidence of hypertension,gastrointestinal reactions,hyperhidrosis,and palpitations in the phenylephrine group was significantly lower than that in the norepinephrine group,and the difference was statistically significant(P<0.05).Conclusion:The safety of phenylephrine is higher in maternal and neonatal,and the preventive effect of hypotension after spinal anesthesia in cesarean section is no different from ephedrine and norepinephrine.
引文
1谭义文,田毅,魏晓,等.蛛网膜下腔阻滞麻醉剖宫产术中应用麻黄碱复合去氧肾上腺素对产妇及新生儿的影响[J].广西医学,2016,38(10):1381-1384.
2 Ripollés Melchor J,Espinosa,Martínez Hurtado E,et al.Colloids versus crystalloids in the prevention of hypotension induced by spinal anesthesia in elective cesarean section.A systematic review and meta-analysis.[J].Minerva Anestesiologica,2015,81(9):1019-1030.
3董延林,夏国生,葛莲芳.预注去氧肾上腺素或麻黄碱对腰麻下剖宫产产妇及新生儿的影响[J].临床麻醉学杂志,2015,31(8):777-779.
4黄伟,徐莉,谢琳丽,等.不同剂量去氧肾上腺素对剖宫产术中大剂量布比卡因腰麻后低血压的预防作用[J].中国计划生育和妇产科,2016,8(6):31-34.
5高华萍,刘文值,李卫.腰-硬联合麻醉剖宫产术中预注去氧肾上腺素与麻黄碱对母婴的影响[J].四川医学,2017,38(4):431-435.
6郑媛媛,邹丽颖,范玲.新产程标准实施后产程中剖宫产指征的变化及母儿预后分析[J].中华妇产科杂志,2016,51(4):245-249.
7 Chan W,Irwin M,Tong W,et al.Prevention of hypotension during spinal anaesthesia for Caesarean section:E-phedrine infusion versus fluid preload[J].Anaesthesia,2015,52(9):908-913.
8柳阳,董有静,李洋,等.联合去氧肾上腺素和麻黄素在产科麻醉中的应用[J].实用药物与临床,2015,18(9):1032-1036.
9车向明.不同药物对剖宫产产妇低血压预防效果的对比[J].河北医学,2016,22(4):661-664.
10曹剑哲,孙艳伟,刘伟璇,等.麻黄碱与去氧肾上腺素联合不同麻醉剂对剖宫产产妇麻醉质量与血流动力学的影响[J].中国计划生育和妇产科,2016,8(9):67-71.
11 Rumboll CK.The use of phenylephrine to obtund oxytocin induced hypotension and tachycardia during elective caesarean section[J].International Journal of Obstetric Anesthesia,2015,24(4):297-302.
12夏江燕,袁静,孙永瀛,等.麻黄碱与去氧肾上腺素对全麻俯卧位手术患者血流动力学影响的比较[J].中华麻醉学杂志,2015,35(8):909-912.
13赵磊,王天龙,肖玮,等.硬膜外局部麻醉药物中添加去氧肾上腺素对老年患者血流动力学影响的初步研究[J].国际麻醉学与复苏杂志,2016,37(8):673-677.
14 Loubert C,Gagnon PO,Fernando R.Minimum effective fluid volume of colloid to prevent hypotension during caesarean section under spinal anesthesia using aprophylactic phenylephrine infusion:An up-down sequential allocation study[J].Journal of Clinical Anesthesia,2017,36(Complete):194-200.
15苏鸿莉,晋雅凌.胶体液预负荷和晶体液共负荷在预防腰麻剖宫产术中低血压效应的临床疗效对比[J].安徽医药,2015,19(11):2210-2212.
16李蒙蒙,张庆.去氧肾上腺素与去甲肾上腺素对限制性输液老年患者组织氧代谢的影响[J].临床麻醉学杂志,2016,32(11):1068-1072.
17韩旭东,耿智隆,范坤,等.不同剂量去氧肾上腺素预防性泵注对腰麻下择期剖宫产产妇血流动力学的影响[J].国际麻醉学与复苏杂志,2015,36(10):904-908.
2 Ripollés Melchor J,Espinosa,Martínez Hurtado E,et al.Colloids versus crystalloids in the prevention of hypotension induced by spinal anesthesia in elective cesarean section.A systematic review and meta-analysis.[J].Minerva Anestesiologica,2015,81(9):1019-1030.
3董延林,夏国生,葛莲芳.预注去氧肾上腺素或麻黄碱对腰麻下剖宫产产妇及新生儿的影响[J].临床麻醉学杂志,2015,31(8):777-779.
4黄伟,徐莉,谢琳丽,等.不同剂量去氧肾上腺素对剖宫产术中大剂量布比卡因腰麻后低血压的预防作用[J].中国计划生育和妇产科,2016,8(6):31-34.
5高华萍,刘文值,李卫.腰-硬联合麻醉剖宫产术中预注去氧肾上腺素与麻黄碱对母婴的影响[J].四川医学,2017,38(4):431-435.
6郑媛媛,邹丽颖,范玲.新产程标准实施后产程中剖宫产指征的变化及母儿预后分析[J].中华妇产科杂志,2016,51(4):245-249.
7 Chan W,Irwin M,Tong W,et al.Prevention of hypotension during spinal anaesthesia for Caesarean section:E-phedrine infusion versus fluid preload[J].Anaesthesia,2015,52(9):908-913.
8柳阳,董有静,李洋,等.联合去氧肾上腺素和麻黄素在产科麻醉中的应用[J].实用药物与临床,2015,18(9):1032-1036.
9车向明.不同药物对剖宫产产妇低血压预防效果的对比[J].河北医学,2016,22(4):661-664.
10曹剑哲,孙艳伟,刘伟璇,等.麻黄碱与去氧肾上腺素联合不同麻醉剂对剖宫产产妇麻醉质量与血流动力学的影响[J].中国计划生育和妇产科,2016,8(9):67-71.
11 Rumboll CK.The use of phenylephrine to obtund oxytocin induced hypotension and tachycardia during elective caesarean section[J].International Journal of Obstetric Anesthesia,2015,24(4):297-302.
12夏江燕,袁静,孙永瀛,等.麻黄碱与去氧肾上腺素对全麻俯卧位手术患者血流动力学影响的比较[J].中华麻醉学杂志,2015,35(8):909-912.
13赵磊,王天龙,肖玮,等.硬膜外局部麻醉药物中添加去氧肾上腺素对老年患者血流动力学影响的初步研究[J].国际麻醉学与复苏杂志,2016,37(8):673-677.
14 Loubert C,Gagnon PO,Fernando R.Minimum effective fluid volume of colloid to prevent hypotension during caesarean section under spinal anesthesia using aprophylactic phenylephrine infusion:An up-down sequential allocation study[J].Journal of Clinical Anesthesia,2017,36(Complete):194-200.
15苏鸿莉,晋雅凌.胶体液预负荷和晶体液共负荷在预防腰麻剖宫产术中低血压效应的临床疗效对比[J].安徽医药,2015,19(11):2210-2212.
16李蒙蒙,张庆.去氧肾上腺素与去甲肾上腺素对限制性输液老年患者组织氧代谢的影响[J].临床麻醉学杂志,2016,32(11):1068-1072.
17韩旭东,耿智隆,范坤,等.不同剂量去氧肾上腺素预防性泵注对腰麻下择期剖宫产产妇血流动力学的影响[J].国际麻醉学与复苏杂志,2015,36(10):904-908.