预注不同血管活性药对重度子痫前期患者腰硬联合麻醉剖宫产母儿的影响

张家泽 张晓

[摘要]目的 研究預注不同血管活性药对重度子痫前期患者腰硬联合麻醉剖宫产母儿的影响。方法 选取我院2016年12月～2017年12月择期拟联合阻滞麻醉下剖宫产术的60例重度子痫前期产妇作为研究对象，按照随机数字表法分为三组，每组各20例。A组泵入麻黄素（2 mg/min），B组泵入去甲肾上腺素（25 μg/min），C组泵注同等容量的生理盐水，比较三组的剖宫产结果。结果 三组产妇第1、10、12、15分钟时的血压水平比较，差异无统计学意义（P>0.05）；C组第3、5、7 min的血压水平低于A、B两组，差异有统计学意义（P<0.05）；三组产妇第1分钟的心率比较，差异无统计学意义（P>0.05）；C组第3、5、7、10、12、15分钟的心率水平高于A、B两组，差异有统计学意义（P<0.05），B组5 min后的心率水平高于A组，差异有统计学意义（P<0.05）；三组新生儿脐动脉、脐静脉中乳酸、PCO2、PO2、BE以及pH水平比较，差异无统计学意义（P>0.05）；A、B两组产妇的恶心呕吐发生率低于C组，差异有统计学意义（P<0.05）。结论 重度子痫前期患者行腰硬联合麻醉剖宫产时，预注麻黄碱以及去甲肾上腺素具有一定的临床价值，能够保证产妇血流动力学稳定，并保持一定的血药浓度，为产妇以及新生儿预后提供保障。

[关键词]血管活性药；重度子痫；剖宫产；腰硬联合麻醉

[中图分类号] R614.4 [文献标识码] A [文章编号] 1674-4721（2018）5（b）-0122-04

Influence of preoperative injection of different vasoactive drugs on the maternal and neonatal during the spinal-epidural anesthesia of cesarean section in severe pre-eclampsia patients

ZHANG Jia-ze ZHANG Xiao

Yangchun Maternity and Child Care Hospital，Guangdong Province，Yangchun 529600，China

[Abstract]Objective To study the influence of preoperative injection of different vasoactive drugs on the maternal and neonatal during the spinal-epidural anesthesia of cesarean section in severe pre-eclampsia patients.Methods From December 2016 to December 2017，60 severe pre-eclampsia patients undergoing the spinal-epidural anesthesia in our hospital were selected as the subjects，and divided to three groups by radom digital table method，20 cases in each group.Group A took the pumping injection of ephedrine （2 mg/min）.Group B took the pumping injection of norepinephrine （25 ug/min）.Group C took the equivalent normal saline.The final outcomes were observed.Results At 1，10，12 and 15 min，there was no significant difference in the blood pressure among three groups （P>0.05）.At 3，5 and 7 min，the blood pressure in Group C was significantly lower than that in Group A and Group B （P<0.05）.At 1 min，there was no significant difference in the heart rate among three groups （P>0.05）.At 3，5，7，10，12 and 15 min，the heart rate in Group C was significantly higher than that in Group A and Group B，the difference was statistically significant （P<0.05）.After 5 min，the heart rate in Group B was significantly higher than that in Group A，the difference was statistically significant （P<0.05）.There were no significant a difference in the lactic acid，PCO2，PO2，BE and pH among three groups （P>0.05）.The incidence rate of nausea and vomiting in Group A and Group B was lower than that in Group C，the difference was statistically significant （P<0.05）.Conclusion During the spinal-epidural anesthesia of cesarean section，the preoperative injection of Ephedrine and Norepinephrine can maintain the hemodynamics stability，keep the blood concentration and improve the maternal and neonatal prognosis.

[Key words]Vasoactive drugs；Severe eclampsia；Cesarean section；Spinal-epidural anesthesia

重度子痫前期属于造成孕产妇死亡的重要因素，由于妊娠晚期具有水肿、蛋白尿以及高血压等妊娠期高血压症状，随后若出现头晕目眩、恶心呕吐、胸闷以及眼冒金花等症状，可判断为先兆子痫，应受到临床重点关注。随着病情的不断发展，一旦发生抽搐、昏迷等现象可诊断为子痫，多发于产前[1-2]。临床上常采取剖宫产对本病进行治疗，其中腰硬联合麻醉被广泛应用于临床，具有起效迅速、阻滞效果显著等优点，但麻醉后，交感神经阻滞对血流动力学影响较大，成为困扰医疗界专业人士的主要问题。相关报道显示[3]，重度子痫前期产妇采取腰硬联合麻醉较为安全，但产妇进行剖宫产时，如何选择疗效确切的升压药物受到医疗界广泛关注。临……