本文關鍵詞：不同劑量甲氧明預泵注對蛛網(wǎng)膜下腔阻滯麻醉下剖宮產(chǎn)產(chǎn)婦及新生兒的影響　出處：《中華實用診斷與治療雜志》2016年04期 　論文類型：期刊論文

  更多相關文章： 剖宮產(chǎn) 甲氧明 蛛網(wǎng)膜下腔阻滯 低血壓 Apgar評分

【摘要】：目的探討不同劑量甲氧明預防性泵注對蛛網(wǎng)膜下腔阻滯麻醉剖宮產(chǎn)產(chǎn)婦血流動力學及新生兒的影響。方法擇期蛛網(wǎng)膜下腔阻滯麻醉剖宮產(chǎn)孕婦80例,隨機分為4組各20例。M1組、M2組、M3組術前分別將2、4、6mg甲氧明加入生理鹽水配成20mL溶液,并于麻醉穿刺成功即刻以0.1、0.2、0.3mg/min速率泵注,對照組不泵注任何藥物。記錄4組產(chǎn)婦入室時(基礎值)、麻醉后1、3min,胎兒娩出時,胎兒娩出后1、3min及術畢血壓、心率變化,觀察術中低血壓、惡心嘔吐、心動過緩等不良反應發(fā)生情況,記錄新生兒Apgar評分及臍靜脈血氣指標。結果 M1組、M2組、M3組、對照組麻醉后1min時收縮壓(systolic blood pressure,SBP)[(106.8±9.6)、(111.2±12.8)、(109.8±11.3)、(107.1±16.5)mm Hg]均較基礎值[(119.8±7.8)、(121.5±8.9)、(116.8±8.9)、(123.4±8.1)mm Hg]下降(P0.01),M1組、M3組、對照組麻醉3min時SBP[(99.4±8.7)、(104.0±15.2)、(99.5±11.6)mm Hg]低于麻醉后1min(P0.05),M1組、M2組、M3組、對照組術畢SBP[(109.4±7.1)、(113.6±9.0)、(111.2±7.6)、(109.9±7.7)mm Hg]均低于基礎值(P0.01);麻醉后1min,M1組、對照組心率較基礎值增高(P0.01),M3組心率較基礎值下降(P0.05),M2組心率與基礎值比較差異無統(tǒng)計學意義(P0.05),胎兒娩出后1min,僅對照組心率較胎兒娩出時增高(P0.01);M1組、M2組分娩前低血壓發(fā)生率(30%、15%)低于對照組(70%),M2組惡心嘔吐發(fā)生率(5%)低于對照組(40%),M3組心動過緩發(fā)生率(40%)高于對照組(0),差異均有統(tǒng)計學意義(P0.05);4組新生兒Apgar評分以及臍靜脈血pH、pa(O_2)、pa(CO_2)比較差異無統(tǒng)計學意義(P0.05)。結論術前以0.2mg/min速率泵注甲氧明可有效預防剖宮產(chǎn)患者麻醉后低血壓,且血流動力學平穩(wěn),新生兒Apgar評分及臍靜脈血氣指標穩(wěn)定。
[Abstract]:Objective to investigate the effects of different doses of methoxifen prophylaxis pump on hemodynamics of parturient and newborn in cesarean section under subarachnoid block anesthesia. Methods 80 pregnant women with selective subarachnoid block anesthesia were performed caesarean section. They were randomly divided into 4 groups (n = 20). M _ 2 group (n = 20), M _ 2 group (n = 20), M _ 2 group (n = 20) and M _ 3 group (n = 20). 0.2 mg / min pump was injected, while the control group was not injected with any drugs. 4 groups were recorded at the time of entering the room (basic value, 1 min after anesthesia, 1 min after delivery of fetus, 1 min after delivery), and 3 min after anaesthesia, 1 min after anaesthesia, 1 min after delivery of fetus and 1 min after delivery. The changes of blood pressure and heart rate at the end of operation were observed, and the adverse reactions such as hypotension, nausea and vomiting, bradycardia were observed, the Apgar score of newborn and the blood gas index of umbilical vein were recorded. Results M1 group. M 2 group M3, control group 1 min after anaesthesia, systolic systolic blood pressure (SBP). [106.8 鹵9.6mHg, 111.2 鹵12.8mHg, 109.8 鹵11.3mHg, 107.1 鹵16.5mm Hg, respectively. [119.8 鹵7.8 + 121.5 鹵8.9 mHg (116.8 鹵8.9 mHg) decreased P0.01mHg in the M1 group. SBP in M3 group and control group during anaesthesia for 3 minutes. [The concentration of 99.4 鹵8.7 MHg in 104.0 鹵15.2mHg was lower than that in M3 group. SBP in control group. [The values of 109.4 鹵7.1mHg and 113.6 鹵9.0mm Hg were all lower than that of the base value (P 0.01). One minute after anesthesia, the heart rate of the control group was higher than that of the basic value, and the heart rate of the M3 group was lower than that of the base value (P0.05). There was no significant difference between heart rate and basic value in M2 group (P 0.05). The heart rate in the control group was higher than that in the control group at 1 min after delivery. The incidence of hypotension in M _ 1 group was lower than that in M _ 2 group (P < 0.05). The incidence of nausea and vomiting in M _ 2 group was lower than that in M _ 2 group (P < 0.05). The incidence of bradycardia in M3 group was higher than that in control group (P 0.05). The neonatal Apgar score and umbilical vein blood pH were evaluated in 4 groups. Conclusion 0.2 mg / min pump before operation can effectively prevent hypotension after anesthesia in patients with cesarean section. The hemodynamics was stable, Apgar score and umbilical vein blood gas index were stable.
【作者單位】： 鄭州大學人民醫(yī)院河南省人民醫(yī)院麻醉科;
【分類號】：R614
【正文快照】： 蛛網(wǎng)膜下腔阻滯麻醉起效快、效果確切,臨床廣泛用于剖宮產(chǎn)術,但低血壓發(fā)生率高、程度嚴重,對產(chǎn)婦及胎兒均有不良影響[1]。甲氧明為一種高選擇性α1受體激動劑,可通過單純縮血管效應增高血壓,在產(chǎn)科手術應用日益受到關注,但其靜脈泵注方法及劑量目前尚未統(tǒng)一。本研究探討不同劑

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