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预防性静脉注射去氧肾上腺素和麻黄碱 对腰硬联合麻醉剖宫产产妇及胎儿的影响

Keywords: 剖宫产术,麻醉,脊椎,麻黄碱,去氧肾上腺素

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Abstract:

目的探讨预防性静脉注射去氧肾上腺素和麻黄碱对腰硬联合麻醉剖宫产产妇及胎儿的影响。方法择期行子宫下段剖宫产术的单胎、足月产妇100例,ASAⅠ或Ⅱ级,随机分为两组(n=50)麻黄碱组(E组)和去氧肾上腺素组(P组)。E组椎管内注射局麻药同时静脉注射麻黄碱5mg,用微量泵持续静脉输注麻黄碱0.83mg?min-1至胎儿娩出;P组椎管内注射局麻药同时静脉注射去氧肾上腺素60μg,用微量泵持续静脉输注去氧肾上腺素16.7μg?min-1至胎儿娩出。采集脐动脉和脐静脉血样行血气分析。记录麻醉诱导至胎儿娩出时间、切皮至胎儿娩出时间、子宫切开至胎儿娩出时间(分娩时间)、新生儿1、5minApger评分。记录产妇不良反应的发生情况(如高血压、低血压、窦性心动过缓、窦性心动过速、恶心呕吐)。结果两组麻醉诱导至胎儿娩出时间,切皮至胎儿娩出时间,子宫切开至胎儿娩出时间比较差异无统计学意义(P>0.05);与E组比较,P组胎儿脐动脉和脐静脉血pH值和BE差异无统计学意义(P>0.05);两组产妇低血压发生率比较差异无统计学意义(P>0.05);与E组比较,P组恶心、呕吐发生率降低(P<0.05)。结论预防性静脉注射去氧肾上腺素和麻黄碱可有效降低腰硬联合麻醉剖宫产产妇低血压发生率,且对胎儿无明显影响。预防性静脉注射去氧肾上腺素可以降低产妇恶心和呕吐。

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