去氧肾上腺素的不同用法对腰-硬联合麻醉下剖宫产时低血压的防治效果比较

目的：探讨去氧肾上腺素的不同用法对腰-硬联合麻醉下剖宫产时低血压的防治效果,为合理应用去氧肾上腺素减少产科麻醉并发症提供参考。方法将ASA分级Ⅰ-Ⅱ级择期或急诊单胎剖宫产患者60例,随机分成A、B两组,均采用腰-硬联合麻醉,腰麻剂量为等比重布比卡因9-10.5 mg、麻醉平面控制在T6-8。A组麻醉成功改左倾15＆#176;平卧位后即刻静脉预注去氧肾上腺素50μg,同时在15 min内快速静脉输注国产羟乙基淀粉10 ml/kg,后以15 ml/（kg·h）速度静脉输注乳酸林格氏液维持,术中根据血压情况可间断重复静脉输注小剂量的去氧肾上腺素,均为50μg/次。B组麻醉方法及预注去氧肾上腺素剂量同A组后,静脉输注含2μg/ml去氧肾上腺素浓度的国产羟乙基淀粉500 ml,初始输注速度为0.5μg/（kg·min）后根据血压情况调节输注速度至手术结束。结果 A组在麻醉成功改平卧位后3 min胎儿娩出后即刻静脉输注缩宫素3 min后有血压降低、心率增快趋势,其中发生低血压者6例包括有2例严重低血压、恶心呕吐2例,与B组比较差异有统计学意义（P〈0.05）;而B组仅1例轻度低血压、无严重低血压及恶心呕吐,有严重心动过缓3例、高血压者2例,经减缓静脉输注速度及（或）静脉推注阿托品后迅速纠正,未造成不良后果。两组输液量A组（1320±280） mlVS B组（750±270） ml,差异有统计学意义（P〈0.05）,两组新生儿Apgar评分差异无统计学意义（P〉0.05）。结论预注＋持续静脉输注小剂量的去氧肾上腺素更有利于产科麻醉中的血流动力学平稳。

Curative effect comparison on different usages of epinephrine for hypotension after combined anaesthesia for caesarean section

Objective To investigate the curative effect of different usages of epinephrine for hypotension after combined anaesthesia for caesarean section to reduce the complications of anesthesia in obstetrics. Methods Divided 60 cesarean section patients（elective or emergency singleton）, ASA grade I-II, into 2 groups. Both groups were used combined spinal-epidural anesthesia. The spinal anesthesia was given isobaric bupivacaine 9-10.5 mg, and the analgesic level was controlled at T6-8 by changing body position. After spinal anesthesia successful, group A was adjusted the position of patients to the left at 15°, was immediately injected phenylephrine 50μg , then injected hydroxyethyl starch at the dose of 10 ml/kg by 15 min, and then injected the ringer lactate solution at the rate of 15 ml/（kg·h） until parturition end. According to intraoperative blood pressure, added the phenylephrine with dose 50μg. Group B was adjusted the position of patients to the left at 15 , was immediately injected phenylephrine 50μg, then injected hydroxyethyl starch（with 2μg/ml pheny-lephrine） at the rate of 0.5 μg/（kg·min） until parturition end. According to intraoperative blood pressure, adjust the hydroxyethyl starch infusion speed. Results After anesthesia, blood pressure and some anaesthetic complications of two group patients were observed respectively at adjusting supine position after 3 minutes, the time after delivery of fetus, and after intravenous infusion of oxytocin;compared with group B, the difference was statistically significant. After anesthesia, the blood pressure of group B was stable. The incidence of hypotension, nausea, vomiting of group A was higher than group B, P〈0.05. Apgar cores of two groups were normal, P〉0.05. Conclusion Pre-injection plus continuous intravenous injection of small dose of epinephrine is more advantageous to the stable hemodynamics in obstetric anesthesia.