不同升压药对剖宫产产妇和新生儿影响的差异

目的探讨苯肾上腺素和麻黄碱在治疗剖宫产产妇低血压时的效果以及影响新生儿预后的差异。方法选择40例择期行剖宫产手术的患者，实施腰硬联合麻醉，输注局麻药后出现低血压时，给予苯肾上腺素100ug（苯肾上腺素组，20例）或麻黄碱10mg（麻黄碱组，20例）处理。围手术期间连续监测产妇的血压、心率（HR）、脉搏血氧饱和度（SpO2），记录手术结束时的失血量、尿量；测量新生儿脐动脉血气分析；记录新生儿1min及5minApgar评分。结果两组新生儿脐动脉血气分析指标中pH值、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、碳酸氢根离子（HCO3-）、动脉血氧饱和度（SaO2）结果均在正常范围，PaO2、PaCO2、SaO2组间比较差异无统计学意义（P〉0．05）；而苯肾上腺素组pH值（7．38±0．07）和HCO3^-（21．5±3．4）mmol／L]与麻黄碱组pH值（7．30±0．02）和HCO3^-（19．3±3．3）mmol／L]组间比较差异有统计学意义（P〈0．05），麻黄碱组胎儿脐动脉血偏酸性。两组新生儿1min及5min Apgar评分组间比较差异无统计学意义（P〉0．05）。两组产妇血压在各观察时间点变化不明显，但HR在麻醉后15min和胎儿取出子宫时苯肾上腺素组低于麻黄碱组（P〈0．05）。结论处理产科麻醉中的低血压，苯肾上腺素也许比麻黄碱更合适。

Effects of different vaso pressor on puerperant with caesarean section and newborn

Objective To study the effects of ephedrine and phenylephedrine for maintenance of arterial pressure during combined spinal/epidural anesthesia （CSEA） for caesarean section. Methods Forty patients, ASA grade Ⅰ - Ⅱ, who were scheduled for caesarean section by CSEA were randomly divided into two groups, when patients were hypotension, phenylephedrine 100 ug （group P, 20 eases） or ephedrine 10 mg （group E, 20 cases）. The variety of blood pressure （Bp）, heart rate （HR） and oxyhemoglohin saturation （SpO2） were monitored; recorded before anesthesia （T0）, at 15 min after anesthesia （TI）, fetuses were taken out of uterus （T2） and at the end of operation （T3）; umbilical arterial blood gas analysis was monitored; neonatal Apgar score was investigated. Results Umbilical arterial blood gas analysis of pH, PaO2, PaCO2, HCO3-, SaO2 were normal in two groups, there were no significant difference in PaO2, PaCO2 and SaO2 between two groups, but pH and HCO3- in group P were higher than those in group E 7.38 ± 0.07 vs 7.30 ±0.02 and （21.5 ±3.4） mmol/L vs （19.3 ±3.3） mmol/L] （P 〈0.05）. There were no significant difference in Apgar score and Bp between two groups. Compared with group P, the HR in group E was increased obviously at T1 and T2 （P 〈 0.05）. Conclusion Phenylephedrine is the vasopressor that most closely meets the criteria for the best vasopressor to use in obstetric patients.