甲氧明和麻黄碱用于防治剖宫产术中低血压作用效果及对产妇.PDFVIP

甲氧明和麻黄碱用于防治剖宫产术中低血压 作用效果及对产妇和胎儿影响的研究 郭晓昱 徐铭军 首都医科大学北京妇产医院，北京，100000 摘要 目的：比较甲氧明和麻黄碱用于预防和治疗腰-硬联合麻醉下剖宫产术中低 血压的作用效果及对产妇和胎儿的影响，以及评价预防性给药和补救性给药两种 给药方式的作用效果。方法：选择拟行择期剖宫产产妇 120 例随机分为四组，I 组：甲氧明预注组（0.20mg/h），II 组：麻黄碱预注组（0.67mg/h），在麻醉穿 刺即刻使用微量注射泵以 40ml/h 的速度分别输注甲氧明或麻黄碱；III 组：甲 氧明补救组（3mg），IV 组：麻黄碱补救组（10mg），当产妇收缩压降低大于基础 值的20%或收缩压低于100mmHg 时，分别给予甲氧明或麻黄碱静脉注射。比较四 组产妇术中血压、心率、恶心呕吐发生率，脐动脉血气分析指标及新生儿Apgar 评分。结果：I 组产妇血压降低较II 组少（P＜0.05），且与II 组相比心率降低 多（P＜0.05），恶心发生率更低（P＜0.05）；III 组与 IV 组相比，产妇血压及 恶心呕吐发生率差异无统计学意义，心率在 III 组低于 IV 组（P＜0.05）；I 组 与II 组比较、III 组与IV 组比较：脐动脉血气pH 值及新生儿Apgar 评分组间 比较差异均无统计学意义。甲氧明预注组（I 组）与补救组（III 组）相比，产 妇血压维持更平稳，心率降低幅度小，恶心呕吐发生率低。结论：适当剂量甲氧 明可纠正产科麻醉中出现的低血压，并且预防性持续输注的给药方式比补救性静 脉注射更为安全有效。 【关键词】 甲氧明；麻黄碱；剖宫产术；腰硬联合麻醉；低血压 Comparison of the impact of methoxamine and ephedrine on maternal and fetal and for the prevention and treatment of hypotension during combined spinal and epidural anesthesia for cesarean section 【Abstract 】 Objective To study the availability and safety of methoxamine and ephedrine for preventing and treating hypotension and the curative effects of different administration methods during combined spinal and epidural anesthesia for cesarean section. Methods A total of 120 women undergoing elective Cesarean section under spinal anesthesia were randomly allocated to four groups with 30 each, received infusion of 0.20mg/h methoxamine (group I) or 0.67mg/h ephedrine (group II) titrated to maintain blood pressure. Immediately after spinal puncture the study solution was started prophylactically in every patient at the rate of 40 ml/h. And following drugs were given when the blood pressure was below the baseline 80%: 3mg methoxamine (group III) or 10mg ephedrine (group IV). The changes of maternal homodynamic, umbilical arteri