CAJ | 학술논문

目的：比较共同负荷联合血管收缩药对腰麻剖宫产术产妇血流动力学及胎儿的影响。方法选择2012年8月-2013年8月在我院待产的单胎足月妊娠产妇150例为研究对象，随机分为E组泵注麻黄碱(8mg/ml)，E+Ph组泵注麻黄碱复合去氧肾上腺素(麻黄碱4mg/ml+去氧肾上腺素50μg/ml)，Ph组泵注去氧肾上腺素(100μg/ml)，每组50例。监测麻醉前基础值（T0）、麻醉后1min(T1)、3min(T2)、5min(T3)、10min(T4)、20min(T5）及手术结束时(T6)产妇的收缩压、舒张压、平均动脉压、心率。胎儿娩出即刻进行脐动脉及脐静脉血血气分析，记录胎儿娩出后1min和5min的Apgar评分。结果与T0时比较，E组T2-T5时和E+Ph组T2-T4时产妇心率明显增快，而Ph组T2-T4时产妇心率明显减慢（P＜0.05）；与T0时比较，T3时3组产妇SBP和DBP明显升高，而T5-T6时3组产妇SBP和DBP呈现下降（P＜0.05）；与Ph组比较，E组T2-T5时和E+Ph组T2-T4时心率明显增快（P＜0.05），E组T4时产妇SBP和DBP轻度下降（P＜0.05）。3组产妇动脉血气分析结果比较差异显著（P＜0.05），E组脐动脉和脐静脉血的pH值和碱剩余分别低于Ph组（P＜0.05），而PCO2和乳酸浓度分别高于Ph组（均P＜0.05），E+Ph组脐动脉和脐静脉血的碱剩余低于Ph组（P＜0.05），而葡萄糖和乳酸浓度均高于Ph组（P＜0.05）。3组新生儿1min和5min的Apgar评分均大于9分，差异无统计学意义（P＞0.05）。结论共同负荷联合输注血管收缩药能有效维持产妇在腰麻后血流动力学稳定，从胎儿安全性评价指标来看，与麻黄碱单独使用相比，去氧肾上腺素或去氧肾上腺素与麻黄碱联合使用对胎儿血气影响较小，能给胎儿提供更安全的生存环境。
목적：비교공동부하연합혈관수축약대요마부궁산술산부혈류동역학급태인적영향。방법선택2012년8월-2013년8월재아원대산적단태족월임신산부150례위연구대상，수궤분위E조빙주마황감(8mg/ml)，E+Ph조빙주마황감복합거양신상선소(마황감4mg/ml+거양신상선소50μg/ml)，Ph조빙주거양신상선소(100μg/ml)，매조50례。감측마취전기출치（T0）、마취후1min(T1)、3min(T2)、5min(T3)、10min(T4)、20min(T5）급수술결속시(T6)산부적수축압、서장압、평균동맥압、심솔。태인면출즉각진행제동맥급제정맥혈혈기분석，기록태인면출후1min화5min적Apgar평분。결과여T0시비교，E조T2-T5시화E+Ph조T2-T4시산부심솔명현증쾌，이Ph조T2-T4시산부심솔명현감만（P＜0.05）；여T0시비교，T3시3조산부SBP화DBP명현승고，이T5-T6시3조산부SBP화DBP정현하강（P＜0.05）；여Ph조비교，E조T2-T5시화E+Ph조T2-T4시심솔명현증쾌（P＜0.05），E조T4시산부SBP화DBP경도하강（P＜0.05）。3조산부동맥혈기분석결과비교차이현저（P＜0.05），E조제동맥화제정맥혈적pH치화감잉여분별저우Ph조（P＜0.05），이PCO2화유산농도분별고우Ph조（균P＜0.05），E+Ph조제동맥화제정맥혈적감잉여저우Ph조（P＜0.05），이포도당화유산농도균고우Ph조（P＜0.05）。3조신생인1min화5min적Apgar평분균대우9분，차이무통계학의의（P＞0.05）。결론공동부하연합수주혈관수축약능유효유지산부재요마후혈류동역학은정，종태인안전성평개지표래간，여마황감단독사용상비，거양신상선소혹거양신상선소여마황감연합사용대태인혈기영향교소，능급태인제공경안전적생존배경。
Objective To compare the differents effects of coload combined with vasoconstrictors on maternal hemodynamic and fetus during spinal anesthesia for cesarean section. Methods One hundred and fifty cases of puerpera with single fetus full-term at our hospital during August 2012-August 2013 were randomly divided into 3 groups (E,E+Ph,Ph,n=50 each).Group E re-ceived an infusion of ephedrine (8mg/ml),Group E+Ph ephedrine plus phenylephrine (ephedrine 4mg/ml+phenylephrine 50μg/ml) and Group Ph phenylephrine (100μg/ml). SBP,DBP,MAP,HR were monitored at after admission to operation room(T0),1,3,5,10 and 20 min after spinal anesthesia administration (T1-T5),and at the end of surgery (T6). At the moment of the baby was delivered umbilical arterial and umbilical venous blood gas were analysed,Newborns 1 and 5 min Apgar scores were estimated. Results HR sped up at T2-T5 in group E and at T2-T4 in Group E+Ph after anesthesia compared to T0,but HR slowed down at T2-T4 in Group Ph (P<0.05), SBP,DBP of 3 groups were higher at T3 and declined at T5-T6 after anesthesia compared to T0 (P<0.05). HR sped up at T2-T5 in group E and at T2-T4 in group E+Ph after anesthesia compared to group Ph (P<0.05),but SBP,DBP slowed down at T4 (P<0.05). there were the obvious difference in 3 groups at umbilical arterial and umbilical venous blood gas(P<0.05). umbilical ar-terial and umbilical venous pH and base excess in group E were lower than in group Ph(P<0.05),but PCO2 and lactate were greater (P<0.05). and base excess in group E+Ph were lower than in group Ph (P<0.05),but glucose and lactate were greater (P<0.05). there were no obvious difference among 3 groups newborns 1 and 5 min Apgar scores(P>0.05). Conclusion Coload combined with vasoconstrictors can effectively maintain maternal hemodynamic stability during spinal anesthesia for cesarean section. Compare with ephedrine alone,phenylephrine or ephedrine plus phenylephrine was little effect on umbilical arterial and umbilical venous blood gas,and no adverse effects on newborns,it was safe.