不同剂量间羟胺输注预防剖宫产腰麻后低血压的有效性

目的比较不同剂量间羟胺对剖宫产腰麻后低血压(SAIH)的预防作用。方法采用随机、双盲、对照临床试验设计,选择择期于腰麻下行剖宫产术的足月、单胎妊娠产妇90例,ASAⅠ或Ⅱ级,随机均分为3组。均采用0.4%布比卡因3 mL(12 mg)行蛛网膜下腔阻滞,推注布比卡因的同时A、B、C组开始泵注间羟胺1.0、1.5、2.0μg·kg^-1·min^-1,直至胎儿娩出后5 min。观察并记录腰麻后低血压发生率,胎儿娩出后低血压发生率,术中高血压、心动过缓、恶心、呕吐发生率,麻黄碱、阿托品用量,新生儿相关指标等。结果 A、B、C组分别完成29、29、28例。B组和C组胎儿娩出前低血压、恶心发生率和麻黄碱用量均显著低于A组(P<0.05),B组和C组之间无显著差异(P> 0.05)。C组高血压发生率显著高于A组、B组(P <0.05)。3组胎儿娩出后低血压及术中心动过缓、呕吐发生率无显著差异(P> 0.05),且均无需应用阿托品纠正心动过缓。3组新生儿Apgar评分、脐动脉血pH值等指标比较无显著差异(P> 0.05)。结论间羟胺1.5μg·kg^-1·min^-1为预防剖宫产SAIH的适宜剂量。

Efficacy of different doses of metaraminol infusion for preventing spinal anesthesia-induced hypotension during cesarean section

AIM To compare different doses of metaraminol for prophylaxis against spinal anesthesia-induced hypotension(SAIH) during cesarean section. METHODS A randomized, double-blinded, controlled study was conducted, including ninety full-term, singleton, pregnant women scheduled for cesarean section, with ASA Ⅰ or Ⅱ. Patients were randomized equally into 3 groups, who received subarachnoid block with 3 mL(12 mg)of 0.4% bupivacaine. The infusion of bupivacaine and metaraminol started at the same time,and group A,B,C received metaraminol with infusion rates of 1.0,1.5,2.0 μg·kg^-1·min^-1 respectively until 5 min after delivery of the fetus. The frequency of SAIH,frequency of post-delivery hypotension,frequency of intra-operative hypertension,bradycardia,nausea and vomiting,intra-operative requirements of ephedrine and atropine were observed and recorded,as well as the relevant outcomes of the neonates. RESULTS There were 29,29 and 28 patients completed the trial in the group A,B and C. The frequency of SAIH before delivery,nausea and the requirements of ephedrine in the group B and group C were lower compared with the group A(P < 0.05). And no significant difference between group B and group C(P > 0.05). The frequency of intra-operative hypertension in the group C was higher compared with the group A and group B(P < 0.05). There was no significant difference in frequency of post-delivery hypotension,bradycardia,vomiting among three groups(P > 0.05),and atropine was not required. There was no significant difference in neonatal outcomes among three groups,such as Apgar score and umbilical artery pH value(P > 0.05). CONCLUSION The reasonable dose of metaraminol for prophylaxis against SAIH during cesarean section is1.5 μg·kg^-1·min^-1.