多巴胺预注射在剖宫产腰硬联合麻醉的临床应用

目的 探讨多巴胺预注射在剖宫产腰硬联合麻醉应用对产妇血流动力学及胎儿安全性的影响。方法 选择2015年1月~2017年1月我院行剖宫产孕妇60例，随机分为多巴胺预注射组和一般腰硬联合麻醉组，各30例。一般腰硬联合麻醉组在麻醉前用6%羟乙基淀粉130/0.4氯化钠注射液进行快速扩容。多巴胺预注射组在一般腰硬联合麻醉组基础上，在麻醉前用微量注射泵以1.2 μg/（kg·min）速度进行多巴胺预注射。记录两组产妇麻醉前、麻醉后5 min、麻醉后10 min、麻醉后15 min心率和血压；麻醉前及麻醉后5 min胎心率；新生儿Apgar评分及脐静脉血pH、PaO2、BE值。结果 麻醉前两组HR、SBP和DBP比较，差异无统计学意义（P＞0.05）。多巴胺预注射组与一般腰硬联合麻醉组麻醉后5 min、麻醉后10 min、麻醉后15 min SBP和DBP与麻醉前比较，差异有统计学意义（P＜0.05）。麻醉后15 min，两组HR与麻醉前比较，差异有统计学意义（P＜0.05）。多巴胺预注射组与一般腰硬联合麻醉组比较，胎心率与新生儿Apgar评分、脐静脉血pH、PaO2、BE比较，差异均无统计学意义（P＞0.05）。结论 多巴胺预注射在剖宫产腰硬联合麻醉应用能更好的减少产妇血压明显波动，保持血流动力学稳定性，更利于保证胎儿的安全。

Clinical Application of Dopamine Pre-injection in Cesarean Section Combined with Spinal Anesthesia

Abstract:Objective To investigate the effect of dopamine pre-injection on maternal hemodynamics and fetal safety in cesarean section combined with spinal anesthesia.Methods From April 2015 to March 2016, 60 pregnant women undergoing cesarean section in our hospital were randomly divided into dopamine pre-injection group and general lumbar and hard anesthesia group, 30 cases each. In general, the combined spinal and epidural anesthesia group was rapidly expanded with 6% hydroxyethyl starch 130/0.4 sodium chloride injection before anesthesia. The dopamine pre-injection group was pre-injected with dopamine at a rate of 1.2 μg/(kg·min) using a microinjection pump prior to anesthesia based on the general combined spinal and anesthesia group. The prenatal anesthesia, 5 min after anesthesia, 10 min after anesthesia, 15 min after anesthesia and blood pressure were recorded. The fetal heart rate before anesthesia and 5 min after anesthesia; neonatal Apgar score and umbilical venous blood pH, PaO2, BE value.Results There was no significant difference in HR, SBP and DBP between the two groups before anesthesia (P>0.05). The difference between SBP and DBP in the dopamine pre-injection group and the general anesthesia group was 5 min after anesthesia, 10 min after anesthesia, and 15 min after anesthesia,the difference was statistically significant(P<0.05).At 15 min after anesthesia, the HR between the two groups was statistically significant (P<0.05). There was no significant difference in fetal heart rate between neonatal Apgar score, umbilical vein blood pH, PaO2 and BE in the dopamine pre-injection group compared with the general lumbar and hard anesthesia group(P>0.05).Conclusion Dopamine pre-injection in cesarean section combined with spinal anesthesia can better reduce the obvious fluctuation of maternal blood pressure, maintain hemodynamic stability, and is more conducive to the safety of the fetus.