本文選題：去氧腎上腺素 + 腰麻　； 參考：《皖南醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:觀察去氧腎上腺素三種不同給藥方式對腰麻剖宮產(chǎn)術(shù)中產(chǎn)婦低血壓及新生兒的影響。方法:選擇擇期腰麻剖宮產(chǎn)產(chǎn)婦120例,隨機(jī)分為三組,每組40例。A組:鞘內(nèi)注藥后立即靜脈注射5ml生理鹽水組;B組:鞘內(nèi)注藥后立即靜脈注射100μg去氧腎上腺素組;C組:鞘內(nèi)注藥后開始靜脈泵注去氧腎上腺素25μg/min組。三組產(chǎn)婦腰麻前均預(yù)輸注羥乙基淀粉10ml/kg,血壓測量周期為每分鐘一次。若連續(xù)兩次測量的收縮壓下降超過基礎(chǔ)值20%,追加靜脈注射去氧腎上腺素50μg,若心率低于60次/min,給予阿托品0.25mg,必要時重復(fù)。監(jiān)測并記錄產(chǎn)婦鞘內(nèi)注藥后20min內(nèi)每分鐘收縮壓、心率;記錄鞘Qg注藥至胎兒取出這段時間內(nèi)去氧腎上腺素和阿托品干預(yù)例數(shù)、次數(shù)以及去氧腎上腺素的總劑量;記錄三組產(chǎn)婦出現(xiàn)反應(yīng)性高血壓、胸悶、惡心、嘔吐的例數(shù);記錄三組新生兒1分鐘、5分鐘Apgar評分及臍帶動、靜脈血氣值。結(jié)果:鞘內(nèi)注藥后前10min,C組產(chǎn)婦的收縮壓、心率變化較A、B組更加平穩(wěn),A組的SBP第4min降至最低,與A組收縮壓基礎(chǔ)值(T_0)比較差異有統(tǒng)計學(xué)意義(P0.05),B組在第3min升至最高,第7min降至最低,與B組T_0比較差異有統(tǒng)計學(xué)意義(P0.05);A組心率在第3min升至最高,與A組心率基礎(chǔ)值(T_0)比較差異有統(tǒng)計學(xué)意義(P0.05);C組需要追加去氧腎上腺素的例數(shù)及次數(shù)明顯少于A、B組(P0.05),C組去氧腎上腺素總劑量明顯高于A、B組(P0.05);與A組相比,B組去氧腎上腺素追加例數(shù)及次數(shù)較少(P0.05)。C組阿托品干預(yù)的例數(shù)明顯低于A、B組(P0.05);C組有1例出現(xiàn)胸悶,未出現(xiàn)惡心、嘔吐,與A組比較,C組胸悶及惡心的發(fā)生率更低(P0.05);A組有2例反應(yīng)性高血壓、B組有3例、C組未出現(xiàn),三組比較差異無統(tǒng)計學(xué)意義(P0.05);三組新生兒1min、5min Apgar評分及臍帶動、靜脈血氣值均在正常范圍,三組比較差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1.去氧腎上腺素三種給藥方式均能夠糾正擇期剖宮產(chǎn)產(chǎn)婦腰麻后低血壓,并且對新生兒無不利影響。2.與間斷靜脈注射(A、B兩組)比較,腰麻后持續(xù)靜脈泵注去氧腎上腺素,產(chǎn)婦的血壓、心率更加穩(wěn)定,不良反應(yīng)更少,且對新生兒無不利影響。
[Abstract]:Objective: to observe the effects of three different administration methods of noradrenaline on hypotension and newborn during cesarean section under spinal anesthesia. Methods: 120 cases of cesarean section with spinal anesthesia were randomly divided into three groups. Group A (n = 40): intrathecal injection of 5ml immediately after intrathecal injection. Group B: intravenous injection of 100 渭 g noradrenaline immediately after intrathecal injection. Group C: intravenous infusion of noradrenaline 25 渭 g/min after intrathecal injection. Hydroxyethyl starch was injected 10 ml / kg before spinal anaesthesia, and blood pressure was measured once a minute. If the systolic blood pressure drop of two consecutive measurements exceeds the base value of 20, add 50 渭 g of noradrenaline intravenously, if heart rate is less than 60 beats / min, give atropine 0.25 mg, repeat if necessary. Systolic blood pressure (SBP) and heart rate (HR) per minute in 20min were monitored and recorded after intrathecal injection, and the number, times and total dose of noradrenaline and atropine were recorded during the period between the administration of QG and fetuses. The cases of reactive hypertension, chest tightness, nausea and vomiting in the three groups were recorded, and the Apgar score of 1 minute and 5 minutes and the blood gas of umbilical artery and vein were recorded. Results: the systolic blood pressure (SBP) and heart rate (HR) of group C were more stable than those of group A (10 min after intrathecal injection), and the 4min of group A was lower than that of group A (P < 0.05). There was a significant difference between group A and group A (P < 0.05) in the 3min and the lowest in group A (P < 0.05). Compared with group B, there was significant difference in heart rate between group A and group B (P 0.05). The heart rate of group A rose to the highest in 3min. Compared with group A, the total dose of noradrenaline in group C was significantly lower than that in group A (P 0.05) and the total dose of noradrenaline in group C was significantly higher than that in group A (P 0.05), and the total dose of noradrenaline in group B was significantly higher than that in group A (P 0.05), and in group A, the total dose of noradrenaline in group B was significantly higher than that in group A (P 0.05), and that in group B was significantly higher than that in group A (P 0.05). The number and frequency of epinephrine supplementation was significantly lower in group C than that in group A B (P 0.05) and the incidence of chest tightness in group C was significantly lower than that in group A (P 0.05), and the incidence of chest tightness in group C was significantly lower than that in group A (P 0.05). There was no nausea and vomiting. The incidence of chest tightness and nausea in group C was lower than that in group A. There were 2 cases of reactive hypertension in group A and 3 cases in group B without nausea and vomiting. There was no significant difference among the three groups (P 0.05). The venous blood gas values were in the normal range, and there was no significant difference among the three groups (P 0.05). Conclusion 1. All three methods of administration of norepinephrine can correct hypotension after spinal anesthesia in elective cesarean section women, and have no adverse effect on newborns. 2. Compared with the two groups, continuous intravenous infusion of noradrenaline after spinal anesthesia, the blood pressure and heart rate of parturient were more stable, the adverse reactions were less, and there was no adverse effect on the newborns.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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