国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2015年
5期
412-416
,共5页
甲氧明%麻黄碱%剖宫产术%腰麻-硬膜外联合麻醉%低血压
甲氧明%痳黃堿%剖宮產術%腰痳-硬膜外聯閤痳醉%低血壓
갑양명%마황감%부궁산술%요마-경막외연합마취%저혈압
Methoxamine%Ephedrine%Cesarean%Combined spinal and epidural anesthesia%Hypotension
目的 比较不同比例甲氧明和麻黄碱联合用于预防腰麻-硬膜外联合麻醉(combined spinal and epidural anesthesia,CSEA)剖宫产术中低血压的作用效果及对母婴的影响,评价联合用药不同药物比例的作用效果.方法 采用随机数字表法将150例拟在CSEA下行剖宫产手术的产妇分成5组(1组～5组,每组30例),分别接受5种不同剂量浓度的甲氧明和麻黄碱混合静脉给药.假设2 mg甲氧明约等效于8 mg麻黄碱,各组比例分别相当于100％、75％、50％、25％、0的甲氧明和0、25％、50％、75％、100％的麻黄碱,调节输注速率以恒速泵注.测定产妇血流动力学变化和脐带血血气,记录新生儿Apgar评分,产妇恶心、呕吐及低血压情况.结果 随1组～5组甲氧明的比例下降和麻黄碱比例的上升,低血压发生率有升高的趋势(1组3％、2组10％、3组7％、4组13％、5组30％)(P＜0.05).2组、3组恶心呕吐发生率低于其他3组(1组7％、2组3％、3组0、4组10、5组23％)(P＜0.05).1组～5组脐动脉胎儿血红蛋白值含量有下降的趋势[1组93(91～98)％、2组89(86～91)％、3组88(85～91)％、4组85(83～89)％、5组81(78～84)％](P＜0.05),二氧化碳分压有逐渐升高的趋势[1组49 (46～54) mmHg、2组51(45～56) mmHg、3组53(47～57)mmHg、4组55(50～59) mmHg、5组56(51～59) mmHg(1 mmHg=0.133 kPa)] (P＜0.05).结论 CSEA下剖宫产术不同剂量甲氧明和麻黄碱复合输注以维持血压时,随着甲氧明比例增大和麻黄碱比例减小,产妇血流动力学能得到更好的控制.0.375g/L甲氧明:0.5 g/L麻黄碱至0.25 g/L甲氧明:1 g/L麻黄碱效果较好,能产生更为有利于胎儿的效应.
目的 比較不同比例甲氧明和痳黃堿聯閤用于預防腰痳-硬膜外聯閤痳醉(combined spinal and epidural anesthesia,CSEA)剖宮產術中低血壓的作用效果及對母嬰的影響,評價聯閤用藥不同藥物比例的作用效果.方法 採用隨機數字錶法將150例擬在CSEA下行剖宮產手術的產婦分成5組(1組～5組,每組30例),分彆接受5種不同劑量濃度的甲氧明和痳黃堿混閤靜脈給藥.假設2 mg甲氧明約等效于8 mg痳黃堿,各組比例分彆相噹于100％、75％、50％、25％、0的甲氧明和0、25％、50％、75％、100％的痳黃堿,調節輸註速率以恆速泵註.測定產婦血流動力學變化和臍帶血血氣,記錄新生兒Apgar評分,產婦噁心、嘔吐及低血壓情況.結果 隨1組～5組甲氧明的比例下降和痳黃堿比例的上升,低血壓髮生率有升高的趨勢(1組3％、2組10％、3組7％、4組13％、5組30％)(P＜0.05).2組、3組噁心嘔吐髮生率低于其他3組(1組7％、2組3％、3組0、4組10、5組23％)(P＜0.05).1組～5組臍動脈胎兒血紅蛋白值含量有下降的趨勢[1組93(91～98)％、2組89(86～91)％、3組88(85～91)％、4組85(83～89)％、5組81(78～84)％](P＜0.05),二氧化碳分壓有逐漸升高的趨勢[1組49 (46～54) mmHg、2組51(45～56) mmHg、3組53(47～57)mmHg、4組55(50～59) mmHg、5組56(51～59) mmHg(1 mmHg=0.133 kPa)] (P＜0.05).結論 CSEA下剖宮產術不同劑量甲氧明和痳黃堿複閤輸註以維持血壓時,隨著甲氧明比例增大和痳黃堿比例減小,產婦血流動力學能得到更好的控製.0.375g/L甲氧明:0.5 g/L痳黃堿至0.25 g/L甲氧明:1 g/L痳黃堿效果較好,能產生更為有利于胎兒的效應.
목적 비교불동비례갑양명화마황감연합용우예방요마-경막외연합마취(combined spinal and epidural anesthesia,CSEA)부궁산술중저혈압적작용효과급대모영적영향,평개연합용약불동약물비례적작용효과.방법 채용수궤수자표법장150례의재CSEA하행부궁산수술적산부분성5조(1조～5조,매조30례),분별접수5충불동제량농도적갑양명화마황감혼합정맥급약.가설2 mg갑양명약등효우8 mg마황감,각조비례분별상당우100％、75％、50％、25％、0적갑양명화0、25％、50％、75％、100％적마황감,조절수주속솔이항속빙주.측정산부혈류동역학변화화제대혈혈기,기록신생인Apgar평분,산부악심、구토급저혈압정황.결과 수1조～5조갑양명적비례하강화마황감비례적상승,저혈압발생솔유승고적추세(1조3％、2조10％、3조7％、4조13％、5조30％)(P＜0.05).2조、3조악심구토발생솔저우기타3조(1조7％、2조3％、3조0、4조10、5조23％)(P＜0.05).1조～5조제동맥태인혈홍단백치함량유하강적추세[1조93(91～98)％、2조89(86～91)％、3조88(85～91)％、4조85(83～89)％、5조81(78～84)％](P＜0.05),이양화탄분압유축점승고적추세[1조49 (46～54) mmHg、2조51(45～56) mmHg、3조53(47～57)mmHg、4조55(50～59) mmHg、5조56(51～59) mmHg(1 mmHg=0.133 kPa)] (P＜0.05).결론 CSEA하부궁산술불동제량갑양명화마황감복합수주이유지혈압시,수착갑양명비례증대화마황감비례감소,산부혈류동역학능득도경호적공제.0.375g/L갑양명:0.5 g/L마황감지0.25 g/L갑양명:1 g/L마황감효과교호,능산생경위유리우태인적효응.
Objective Comparing the effects of combinations of methoxamine and ephedrine in varying proportions on preventing hypotension and maternal fetal to evaluate the curative effects of drug combinations in different proportions during combined spinal and epidural anesthesia (CSEA) for cesarean section.Methods One hundred and fifty parturients undergoing CSEA for elective cesarean delivery were randomly divided into five groups with 30 each parturients to receive intravenous administration of combinations of methoxamine and ephedrine in different proportions,respectively.Assuming that 2 mg methoxamine to be approximately equipotent to 8 mg ephedrine,five combinations drugs were infused in differents proportions which were potency equivalent of 100％,75％,50％,25％ or 0 of methoxamine and 0,25％,50％,75％ or 100％ of ephedrine,respectively.Changes of maternal homodynamic and umbilical arterial blood gas analysis were measured.Infant Apgar score and incidence of maternal nausea and vomiting were also recorded.Results With the decreased proportion of methoxamine and increased ephedrine in these groups,the incidences of hypotension[group 1 (3％),group 2(10％),group 3(7％),group 4 (13％),group 5(30％)] showed a rising trend (P＜0.05).The increased of nausea/vomiting of group 2 and 3 was lower than other three groups [(group 1 7％),group 2 (3％),group 3 (0％),group 4 (10％),group 5 (23％)] (P＜0.05).The study showed a downtrend of the incidence of umbilical arterial fetal hemoglobin from group 1 to group 5[group 1 93(91-98)％,group 2 89(86-91)％,group 3 88(85-91)％、group 4 85(83-89)％、group 5 81(78-84)％](P＜0.05) and and a uptrend of partial pressure of carbon dioxide[group 1 49(46-54) mmHg、group 2 51(45-56) mmHg,group 3 53(47-57) mmHg,group 4 55(50-59) mmHg,group 5 56(51-59) mmHg(1 mmHg=0.133 kPa)](P＜0.05).Conclusions Combinations of methoxamine and ephedrine infused to maintain arterial blood pressure during CSEA for cesarean delivery in the proportion decreased of ephedrine and the increased proportion of methoxamine exhibits a strengthened control of maternal hemodynamic.The study shows that the range of combinations drugs from 0.375 g/L methoxamine:0.5 g/L ephedrine to 0.25 g/L methoxamine:1 g/L ephedrine can produce more beneficial effect on the fetus.
