麻黄碱与去氧肾上腺素对腰麻剖宫产产妇及新生儿的影响被引量：47

Effects of ephedrine and phenylephrine on maternal and infant outcomes during spinal anesthesia for Cesarean delivery

下载PDF

导出

摘要目的比较麻黄碱与去氧肾上腺素用于腰麻剖宫产术中血压维持接近基础值时对产妇及新生儿的影响。方法择期行腰麻下剖宫产术单胎足月产妇60例,随机均分为两组:Ⅰ组泵注麻黄碱4mg/ml,Ⅱ组泵注去氧肾上腺素50μg/ml。术中调整药物输注速度以维持血压接近基础值。监测用药1、3、5、10min、切皮时及子宫切开时MAP和HR。胎儿娩出即刻取产妇动脉血、脐动脉及脐静脉血进行血气分析和乳酸及血糖浓度检测。结果Ⅰ组脐动脉及脐静脉血pH值和碱剩余低于Ⅱ组(P<0.05),PCO2、乳酸和血糖浓度高于Ⅱ组(P<0.05)。结论去氧肾上腺素对腰麻剖宫产产妇及新生儿影响小于麻黄碱。 Objective To compare the effects of ephedrine and phenylephrine on maternal and infant outcomes when maintaining maternal blood pressure near baseline during spinal anesthesia for Cesarean delivery. Methods Sixty in-term parturients with singleton scheduled for selective Cesarean section under spinal anesthesia were randomly divided into two groups with 30 cases each. Group I was infused ephedrine（4 mg/ml） and group II phenylephrine（50 μg/ml）. Blood pressure was maintained near the baseline by adjusting the drug infusion rate. MAP and HR were monitored at the time points of 1,3,5,10 rain, skin incision and uterus incision after drug administration. Blood samples of maternal artery, umbilical artery and vein were collected immediately after delivery for blood gas analysis and detection of lactate and glucose. Results The umbilical arterial and venous pH and base excess in group I were significantly lower than those in group Ⅱ （P 〈 0. 05 ）, but PCO2 and plasma concentrations of lactate and glucose in group I were higher than those in group Ⅱ （P〈0. 05）. Conclusion Phenylephrine has less effect on maternal and infant outcomes than ephedrine for patients undergoing Cesarean section under spinal anesthesia.

作者王猛韩传宝钱燕宁

机构地区南京医科大学第一附属医院麻醉科南京医科大学附属无锡妇幼保健院麻醉科

出处《临床麻醉学杂志》 CAS CSCD 北大核心 2010年第8期664-666,共3页 Journal of Clinical Anesthesiology

关键词麻黄碱去氧肾上腺素腰麻剖宫产 Ephedrine Phenylephrine Spinal anesthesia Cesarean section

分类号 R614 [医药卫生—麻醉学]

引文网络
相关文献

参考文献10

1Ngan Kee WD,Khaw KS,Tan PE,et al.Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery.Anesthesiology,2009,111:506-512.
2Saravanan S,Kocarev M,Wilson RC,et al.Equivalent dose of ephedrine and phenylephrine in the prevention of post-spinal hypotension in Caesarean section.Br J Anaesth,2006,96:95-99.
3黄绍强.预防剖宫产脊麻后低血压的研究进展[J].临床麻醉学杂志,2009,25(1):88-90. 被引量：70
4Lee A,Ngan Kee WD,Gin T.A quantitative systematic review of randomized controlled trials of ephedrine compared with phenylephrine for t he management of hypotension during spinal anesthesia for cesarean delivery.Anesth Analg,2002,94:920-926.
5Ngan Kee WD,Lau TK,Khaw KS,et al.Comparison of metaraminol and ephedrine infusions for maintaining arterial pressure during spinal anesthesia for elective cesarean section.Anesthesiology,2001,95:307-313.
6Cooper DW,Carpenter M,Mowbray P,et al.Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery.Anesthesiology,2002,97:1582-1590.
7Lee A,Ngan Kee WD,Gin T.A dose response meta-analysis of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for elective cesarean delivery.Anesth Analg,2004,98:483-490.
8Ngan Kee WD,Lee A.Multivariate analysis of factors associated with umbilical arterial pH and standard base excess after caesarean section under spinal anaesthesia.Anaesthesia,2003,58:125-130.
9Ngan Kee WD,Khaw KS,Ng FF,et al.Prophylactic phenylephrine infusion for the prevention of hypotension during spinal anesthesia for cesarean delivery.Anesth Analg,2004,98:815-821.
10Ngan Kee WD,Khaw KS,Lau TK,et al.A Randomized double-blinded comparison of phenylephrine versus ephedrine for maintaining blood pressure during spinal anaesthesia for nonelective Caesarean section.Anaesthesia,2008,107:1319-1326.

二级参考文献17

1Bryson GL, Macneil R, Jeyaraj LM,et al. Small dose spinal bupivacaine for Cesarean delivery does not reduce hypotension but accelerates motor recovery. Can J Anaesth, 2007,54: 531- 537.
2Van de Velde M, Van Schoubroeck D, Jani J,et al. Combined spinal-epidural anesthesia for cesarean delivery: dosedependent effects of hyperbaric bupivaeaine on maternal hemodynamics. Anesth Analg, 2006,103 : 187-190.
3Hallworth SP, Fernando R, Columb MO, et al. The effect of posture and barieity on the spread of intrathecal bupivacaine for elective cesarean delivery. Anesth Analg, 2005, 100: 1159-1165.
4Coppejans HC, Hendrickx E, Goossens J,et al. The sitting versus right lateral position during combined spinal-epidural anesthesia for cesarean delivery: block characteristics and severity of hypotension. Anesth Analg, 2006, 102 : 243-247.
5Kundra P, Khanna S, Habeebullah S, et al. Manual displacement of the uterus during Caesarean section. Anaesthesia, 2007,62 : 460-465.
6Simon L, Boulay G, Ziane AF,et al. Effect of injection rate on hypotension associated with spinal anesthesia for cesarean section. Int J Obstet AneSth, 2000,9 : 10-14.
7Singh SI, Morley-Forster PK, Shamsah M,et al. Influence of injection rate of hyperbaric bupivacaine on spinal block in parturients:a randomized trial. Can J Anaesth, 2007, 54: 290- 295.
8Hanss R, Bein B, Francksen H,et al. Heart rate variabilityguided prophylactic treatment of severe hypotension after subarachnoid block for elective cesarean delivery. Anesthesiology, 2006,104 : 635-643.
9Erkinaro T, Makikallio K, Kavasmaa T, et al. Effects of ephedrine and phenylephrine on uterine and placental circulations and fetal outcome following fetal hypoxaemia and epidural-induced hypotension in a sheep model. Br J Anaesth, 2004,93: 825-832.
10Gogarten W, Struemper D, Gramke HF,et al. Assessment of volume preload on uteroplacental blood flow during epidural anaesthesia for Caesarean section. Eur J Anaesthesiol, 2005, 22:359-362.