预防性静脉注射小剂量多巴胺在腰-硬联合麻醉剖宫产手术中的应用.docVIP

精品论文 参考文献 预防性静脉注射小剂量多巴胺在腰-硬联合麻醉剖宫产手术中的应用 仲艳玲 陈静 邓友明 张维峰 殷国平 王佳 解东明 　　[摘 要]目的:探讨预防性静脉注射小剂量多巴胺对腰-硬联合麻醉剖宫产术产妇血流动力学及胎儿酸碱值的影响。方法:选取60 例择期在腰-硬联合麻醉下行剖宫产的产妇,随机分为两组:多巴胺组(D组,n ＝30)和麻黄碱(E组,n ＝30),分别于椎管内麻醉操作结束平卧后，静脉推注多巴胺1mg及麻黄碱3mg，记录麻醉前、蛛网膜下腔给药后1min、3 min、5 min、10 min及切皮时的收缩压(SBP)、心率(HR)；记录断脐即刻脐静脉血气和新生儿1 min 和5 min 时的Apgar评分；并观察记录麻醉手术过程中产妇高血压、心动过速、恶心呕吐及寒颤的发生率。结果:两组孕妇术前一般资料比较差异无统计学意义。组间比较：D组腰麻给药后3min、5minSBP 高于E 组，HR低于E组，差异有统计学意义；组内比较：D组组内不同时间的SBP 比较差异无统计学意义 ，E组腰麻给药后3min、5min SBP比麻醉前低且3min、5min、10min HR比麻醉前高，差异有统计学意义。D组低血压及心动过速发生率低于E 组，两组恶心呕吐发生率比较差异无统计学意义。两组新生儿出生后Apgar评分比较差异无统计学意义；娩出即刻脐静脉血气分析D组PCO2较E组低，PO2较E组高，差异有统计学意义。结论:预防性静脉注射多巴胺1mg能有效预防腰麻引起的孕妇低血压及恶心呕吐等麻醉不良反应，对胎儿未见不良反应。 　　[关键词]剖宫产 小剂量 多巴胺 血流动力学变化 麻黄碱 　　DOI:10.3760/cma.j.issn.0376-2491.2015.32.28 　　作者单位：仲艳玲，邓友明，张维峰，殷国平，王佳，解东明，210003，江苏南京，南京市第二医院麻醉科；陈静，210002，江苏南京，南京八一医院麻醉科 　　Preventive effect of low dose dopamine for combined spinal- epidural anesthesia in caesarean section 　　Zhong Yanling, Chen Jing，Deng Youming, Zhang Weifeng，Yin Guoping, Wang Jia，Xie Dongming 　　Abstract: Objective：To investigate the prevent effect of low doses dopamine for maternal hemodynamics after combined spinal- epidural anesthesia during cesarean section and the fetal acid-base.Methods：Sixty patients scheduled for spinal- epidural anesthesia were randomly divided into two groups ，that was group D and E, with 30 cases each. After an induction of intrathecal anesthesia, the patients in group D received an infusion of dopamine 1mg in 1 min ,while the patients in group E received an infusion of ephedrine 3mg in 1 min . Blood pressure and heart rate were recorded before anesthesia（T0）, 1（T2）, 3（T3）, 5（T4） and 10 min （T5）after anesthesia and at the beginning of surgery（T6）. Record Umbilical venous blood gas analysis at the time of clamping. Recorded the Apgar score of the newborn at 1 min and 5 min. Recorded hypertension, tachycardia, nausea, vomiting and chills of maternal during anesthesia.Results：There was no statistically si