去氧肾上腺素维持腰-硬联合麻醉下剖宫产术中血液循环稳定的观察

目的：观察用微量泵持续静脉推注去氧肾上腺素对腰-硬联合麻醉下剖宫产术中血液循环稳定的影响。方法：选择100例择期剖宫产产妇，随机分为F组（在鞘内注局麻药即刻以25-100μg/min静脉泵入去氧肾上腺素维持循环稳定）和M组（根据血压下降程度，静注麻黄碱5 mg）。记录麻醉后多时点的血压，心率，恶心、呕吐发生情况，失血量，输液量，新生儿生后Apgar评分情况，胎儿娩出即刻脐静脉血血气分析指标。结果：F组各时点观察指标均优于M组（P〈0.05），与麻醉前比较差异无统计学意义（P〉0.05）；M组各时点血压与麻醉前比较差异有统计学意义（P〈0.05），心率在麻醉后5 min时减慢（P〈0.05）；F组脐静脉血气pH值、BE值均高于M组（P〈0.05），PaCO2低于M组（P〈0.05）；F组恶心、呕吐率低于M组（P〈0.05）。结论：以25-100μg/min静脉泵入去氧肾上腺素，更能稳定腰-硬联合麻醉下剖宫产术中产妇的血液循环。

Observation of the Stability of Blood Circulation during the Operation of Cesarean Section under Combined Spinal-epidural Anesthesia Being Maintained Using Phenylephrine

Objective：To observe the stability of blood circulation during the operation of cesarean section under combined spinal-epidural anesthesia being maintained through keeping intravenous injection of phenylephrine using micro pump.Method：100 patients undergoing elective cesarean section were randomly divided into group F（intrathecal injection of local anesthetic in order to 25-100μg/min immediate intravenous infusion of phenylephrine to maintain loop stability）and group M（according to the degree of decrease in blood pressure,intravenous ephedrine 5 mg）. The blood pressure,heart rate,the occurrence of nausea and vomit,bleeding volume,transfusion volume and the Apgar index for the new born at multiple time points after anesthesia were measured. Also,the blood gas analytical indexes of the blood taken from umbilical vein upon the moment the baby delivered were measured.Result：All measure indexes for group F at different time points were better than those of group M（P〈0.05）;compared with pre-anesthesia ,there were no statistical differences（P〉0.05）.In group M,compared with pre-anesthesia state,there were statistical differences in blood pressure at different time points（P〈0.05）;heart rate was lowed at 5 minute after enesthesia（P〈0.05）.The pH value and BE value of group F reported upon blood gas analysis tested on the blood taken from umbilical vein were higher than those of group M（P〈0.05）;PaCO2 of group F was lower than that of group M（P〈0.05）;nausea and vomiting rate of group F was lower than that of group M（P〈0.05）. Conclusion：Intravenous injection of phenylephrine at a speed of 25-100μg/min using micro pump helps the stabilization of blood circulation of a puerpera during the operation of cesarean section under combined spinal-epidural anesthesia.