卢盛位,吴小燕,谷艳娟,梁海强
LU Shengwei,WU Xiaoyan,GU Yanjuan,LIANG Haiqiang

• 1:中山市坦背医院麻醉科

摘要(Abstract)：

目的:探讨小剂量预注射联合手术中持续泵注甲氧明对剖宫产产妇血流动力学及新生儿血气指标的影响。方法:选择在腰麻硬膜外联合阻滞下行剖宫产术产妇90例,随机分为3组,3组均采取蛛网膜下腔注射布比卡因麻醉,M_1组于蛛网膜下腔注入药物时静脉注射甲氧明2 mg后、以100μg/min持续泵注甲氧明至术毕,M_2组当收缩压(SBP)降低基础值的20%时、单次静脉注射甲氧明3 mg,C组当SBP降低基础值的20%时、单次静脉注射麻黄碱10 mg;比较各组产妇入室时(T_0)、麻醉后5 min(T_1)、麻醉后10 min(T_2)、麻醉后30 min(T_3)、术毕(T_4)SBP、舒张压(DBP)及心率(HR)的变化,检测各组新生儿脐动脉血pH值、氧分压(PO_2)、二氧化碳分压(PCO_2)及碱剩余(BE)。结果:与M_1组比较,T_1时点M_2组和C组SBP、DBP显著降低(P<0.05),T_2时点M_2组HR显著降低,C组显著增高(P<0.05);C组新生儿脐动脉血气pH值和BE值显著低于M_1组和M_2组(P<0.05)。结论:预注射联合术中持续泵注甲氧明可使腰硬联合阻滞下剖宫产产妇血流动力学更稳定,胎儿酸碱平衡更稳定。
Objective: To investigate the effect of pre-infusion combined with continuous pump injection of metoxamine during cesarean section on maternal hemodynamics and neonatal blood gas index.Methods: Selecting 90 maternal cases to perform spinal-epidural anesthesia in cesarean section,they were randomly divided into 3 groups; three groups were injected with bupivacaine for anesthesia in subarachnoid space. M_1 group subarachnoid space injection was combined with injection of intravenous 2 mg methoxamine after 100 g/min continuous infusion until the end of operation; concerning M_2 group,when the systolic blood pressure( SBP) below 20 %,a single time intravenous dose of methoxamine 3 mg was injected; concerning C group,when the systolic blood pressure( SBP) was below20 %,a single time intravenous ephedrine 10 mg was injected. Comparing time admitting to the surgery T_0,5 min after anesthesia( T_1),10 min after anesthesia(T_2),30 min after anesthesia(T_3)and the end of operation( T_4),systolic blood pressure( SBP),diastolic blood pressure( DBP) and heart rate( HR) changes; testing neonatal umbilical cord arterial blood gas values,PO_2,PCO_2 and BE. Results: Comparing with M_1 group,M_2 group and C group at T_1 showed significant decrease of SBP and DBP( P < 0. 05); at T_2,M_2 group showed significant HR decrease,while C group showed obvious increase( P < 0. 05); C group neonatal umbilical cord arterial blood p H value and BE value was significantly lower than that of M_1 group and M_2 group( P < 0. 05). Conclusion: Pre-injection combined with continuous pump injection of metoxamine can make the hemodynamics more stable and fetal acid-base balance is more stable.

关键词(KeyWords)： 甲氧明;麻醉;剖宫产术;血流动力学;血气分析
metoxamine;anesthesia;cesarean section;hemodynamics;blood gas analysis

Abstract:

Keywords:

基金项目(Foundation): 中山市科技局科学事业项目(2015B1285)

作者(Author): 卢盛位,吴小燕,谷艳娟,梁海强
LU Shengwei,WU Xiaoyan,GU Yanjuan,LIANG Haiqiang

DOI: 10.19367/j.cnki.1000-2707.2017.01.025

参考文献(References)：

• [1]Miller RD.Miller's Anesthesia[M].Churchill Livingstone,2014:2234-2236.
• [2]李黎,姜丽华,顾士敏,等.静脉预注甲氧明对剖宫产腰硬联合麻醉低血压的防治效果[J].临床麻醉学杂志,2012(10):1001-1003.
• [3]赵状,金民想,宋雪,等.不同浓度葡萄糖复合罗哌卡因用于剖宫产患者腰麻的效果[J].临床麻醉学杂志,2012(20):1153-1154.
• [4]庄心良,曾因明,陈伯銮.现代麻醉学[M].4版.北京:人民卫生出版社,2014:1078
• [5]毕严斌,王月兰.麻黄碱治疗腰麻剖宫产术低血压对脐动脉血气及胎儿的影响[J].临床麻醉学杂志,2008(7):580-583.
• [6]Mercier FJ,Riley ET,Frederickson WL,et al.Phenny lephrine added to Prophylactic ephedrine infusion during spinal anesthesia for elective cesarean section[J].Anesthesiology,2001(3):668-674.
• [7]Riley ET.Editorial I:Spinal anesthesia for caesarean delivery:Keep the pressure up and do not spare the vasoconstrictor[J].Br J Anaesth,2004(4):459-461.
• [8]Thieler H,Nermergute C,Lynch C,et al.The physiologic in placations of isolated alphl adrenergic stimulation[J].Anesthanalg,2011(2):284-286.
• [9]Cooper DW.Caesarean delivery vasopress or management[J].Curropin Anesthesia,2012(3):200-202.
• [10]Berlin Y.The treatment should not be worse than the disease[J].Anesthesiology,2006(6):1348-1349.

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