去甲肾上腺素预泵注对腰硬联合麻醉下剖宫产产妇血流动力学影响的临床观察

陆松虹; 徐晖; 程亮; 鲍奎斌; 刘倩影; 张访

doi:10.13898/j.cnki.issn.1000-2200.2022.11.016

去甲肾上腺素预泵注对腰硬联合麻醉下剖宫产产妇血流动力学影响的临床观察

Clinical observation of the effect of pre-pumping norepinephrine on hemodynamics of cesarean section parturients under combined spinal-epidural anesthesia

摘要

摘要:
目的观察预泵注去甲肾上腺素对腰硬联合麻醉后剖宫产病人血流动力学的影响。
方法选择60例ASA Ⅰ~Ⅱ级、择期行腰硬联合麻醉后剖宫产病人，随机分为观察组和对照组，各30例。所有病人麻醉前30 min输注羟乙基淀粉10 mL/kg，腰硬联合麻醉穿刺开始时对照组病人持续泵注0.9%氯化钠溶液0.75 mL·kg^-1·h^-1，观察组持续泵注去甲肾上腺素0.75 mL·kg^-1·h^-1（0.05 μg·kg^-1·min^-1），直至胎儿娩出。比较2组入室时（T₀）、扩容后（T₁）、麻醉后1 min（T₂）、麻醉后3 min（T₃）、胎儿娩出时（T₄）、术毕（T₅）时的平均动脉压（MAP）、心率（HR），新生儿1 min、5 min Apgar评分及不良反应发生情况。
结果2组病人手术时间、麻醉操作时间及出血量差异均无统计学意义（P>0.05）。2组病人T₀时MAP、HR差异均无统计学意义（P>0.05）；观察组T₂时MAP高于对照组（P < 0.05），T₂、T₃时HR低于对照组（P < 0.01和P < 0.05）；与T₀时比较，对照组病人MAP在麻醉后有所降低，但差异无统计学意义（P>0.05），T₂、T₃时HR增快（P < 0.05）；观察组病人各时点MAP和HR与T₀时差异均无统计学意义（P>0.05）。2组病人低血压、高血压、恶心呕吐和心动过缓发生率差异均无统计学意义（P>0.05）。2组新生儿1 min、5 min Apgar评分差异均无统计学意义（P>0.05）。
结论麻醉前预泵注去甲肾上腺素0.05 μg·kg^-1·min^-1，产妇血流动力学平稳，对新生儿无影响，能够提高剖宫产母婴安全。

Abstract:
ObjectiveTo observe the effect of pre-pumping norepinephrine on hemodynamics of cesarean section patients under combined spinal-epidural anesthesia.
MethodsSixty ASA Ⅰ-Ⅱ patients with elective cesarean section after combined spinal-epidural anesthesia were randomly divided into the observation group and control group, with 30 cases in each group.All patients were infused with mL/kg hydroxyethyl starch 30 min before anesthesia.At the beginning of combined spinal-epidural anesthesia, the patients in the control group were continuously pumped with 0.75 mL·kg^-1·h^-1 of 0.9% sodium chloride solution, and the patients in the observation group were continuously pumped with 0.75 mL·kg^-1·h^-1 (0.05 μg·kg^-1·min^-1) of noradrenaline until delivery of the fetus.The mean arterial pressure (MAP), heart rate (HR), 1 min and 5 min Apgar score of neonate, and adverse reactions were compared between the two groups at the time of admission (T₀), after volume expansion (T₁), 1 min after anesthesia (T₂), 3 min after anesthesia (T₃), at the time of fetal delivery (T₄), and at the end of operation (T₅).
ResultsThere was no significant difference in operation time, anesthesia time and bleeding volume between the two groups (P>0.05).There was no significant difference in MAP and HR between the two groups at T₀ (P>0.05);the MAP in the observation group at T₂ was higher than that in the control group (P < 0.05), and the HR at T₂ and T₃ was lower than that in the control group (P < 0.01 and P < 0.05);compared with T₀, the MAP in the control group decreased after anesthesia, but the difference was not statistically significant (P>0.05), and the HR increased at T₂ and T₃ (P < 0.05);there was no significant difference in MAP and HR between each time point and T₀ in the observation group (P>0.05).There was no significant difference in the incidence of hypotension, hypertension, nausea and vomiting, and bradycardia between the two groups (P>0.05).There was no significant difference in 1 min and 5 min Apgar score between the two groups (P>0.05).
ConclusionsPre-pumping 0.05 μg·kg^-1·min^-1norepinephrine before anesthesia can stabilize the maternal hemodynamics, and has no effect on the neonate, which can improve the safety of the mother and baby in cesarean section.

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