实用药物与临床
實用藥物與臨床
실용약물여림상
Practical Pharmacy and Clinical Remedies
2015年
9期
1032-1036
,共5页
柳阳%董有静%李洋%王镜源
柳暘%董有靜%李洋%王鏡源
류양%동유정%리양%왕경원
去氧肾上腺素%麻黄素%联合用药%剖宫产%低血压%新生儿
去氧腎上腺素%痳黃素%聯閤用藥%剖宮產%低血壓%新生兒
거양신상선소%마황소%연합용약%부궁산%저혈압%신생인
Phenylephrine%Ephedrine%Combined medication%Cesarean section%Hypotension%Newborn
目的 探讨联合应用麻黄素和去氧肾上腺素对剖宫产术中产妇和新生儿的影响. 方法 选择ASAⅠ~Ⅱ级,无其他并发症择期足月妊娠剖宫产患者200例,随机分为5组,每组40 例. 麻醉后血压下降(较基础值低20%,或收缩压低于90 mmHg)的患者给予升压药物处理. A组给去氧肾上腺素100 μg;B组给麻黄素8 mg;C组给予麻黄素和去氧肾上腺素联合用药,其中C1组为麻黄素2 mg+去氧肾上腺素75 μg,C2 组为麻黄素4 mg+去氧肾上腺素50 μg,C3组为麻黄素6 mg+去氧肾上腺素25 μg. 记录患者血压、心率值,使用升压药的次数、总剂量,给药后心动过速和心率过缓发生率,使用阿托品例数,记录产妇有无恶心、呕吐等不良反应的情况. 胎儿娩出后,取脐动脉血样本进行血气分析,测定脐血pH值、PCO2、PO2、血糖、乳酸值、HCO3、BE值. 记录新生儿出生后1 min、5 min的Apgar评分. 若患者血压不下降,不予处理,记录心率及胎儿脐血气值,作为对照.结果 A组患者心率减慢(P<0.05),但胎儿脐血气分析与未给药组比较差异无统计学意义(P>0.05). B组患者心率增快明显(P<0.05),恶心呕吐发生率高(P<0.05),且脐血气分析pH值、HCO3 值、BE值明显降低(P<0.05). C组心率较为平稳. 其中C2组心率、血压更为稳定,虽然HCO3 值较未给药组差异有统计学意义( P<0.05),但较B组有优势(P<0.05). 胎儿娩出后Apgar评分比较差异无统计学意义. 结论 在剖宫产术中,联合应用麻黄素和去氧肾上腺素较单独使用其一改善血压、心率的效果更为良好,且对胎儿影响较小.
目的 探討聯閤應用痳黃素和去氧腎上腺素對剖宮產術中產婦和新生兒的影響. 方法 選擇ASAⅠ~Ⅱ級,無其他併髮癥擇期足月妊娠剖宮產患者200例,隨機分為5組,每組40 例. 痳醉後血壓下降(較基礎值低20%,或收縮壓低于90 mmHg)的患者給予升壓藥物處理. A組給去氧腎上腺素100 μg;B組給痳黃素8 mg;C組給予痳黃素和去氧腎上腺素聯閤用藥,其中C1組為痳黃素2 mg+去氧腎上腺素75 μg,C2 組為痳黃素4 mg+去氧腎上腺素50 μg,C3組為痳黃素6 mg+去氧腎上腺素25 μg. 記錄患者血壓、心率值,使用升壓藥的次數、總劑量,給藥後心動過速和心率過緩髮生率,使用阿託品例數,記錄產婦有無噁心、嘔吐等不良反應的情況. 胎兒娩齣後,取臍動脈血樣本進行血氣分析,測定臍血pH值、PCO2、PO2、血糖、乳痠值、HCO3、BE值. 記錄新生兒齣生後1 min、5 min的Apgar評分. 若患者血壓不下降,不予處理,記錄心率及胎兒臍血氣值,作為對照.結果 A組患者心率減慢(P<0.05),但胎兒臍血氣分析與未給藥組比較差異無統計學意義(P>0.05). B組患者心率增快明顯(P<0.05),噁心嘔吐髮生率高(P<0.05),且臍血氣分析pH值、HCO3 值、BE值明顯降低(P<0.05). C組心率較為平穩. 其中C2組心率、血壓更為穩定,雖然HCO3 值較未給藥組差異有統計學意義( P<0.05),但較B組有優勢(P<0.05). 胎兒娩齣後Apgar評分比較差異無統計學意義. 結論 在剖宮產術中,聯閤應用痳黃素和去氧腎上腺素較單獨使用其一改善血壓、心率的效果更為良好,且對胎兒影響較小.
목적 탐토연합응용마황소화거양신상선소대부궁산술중산부화신생인적영향. 방법 선택ASAⅠ~Ⅱ급,무기타병발증택기족월임신부궁산환자200례,수궤분위5조,매조40 례. 마취후혈압하강(교기출치저20%,혹수축압저우90 mmHg)적환자급여승압약물처리. A조급거양신상선소100 μg;B조급마황소8 mg;C조급여마황소화거양신상선소연합용약,기중C1조위마황소2 mg+거양신상선소75 μg,C2 조위마황소4 mg+거양신상선소50 μg,C3조위마황소6 mg+거양신상선소25 μg. 기록환자혈압、심솔치,사용승압약적차수、총제량,급약후심동과속화심솔과완발생솔,사용아탁품례수,기록산부유무악심、구토등불량반응적정황. 태인면출후,취제동맥혈양본진행혈기분석,측정제혈pH치、PCO2、PO2、혈당、유산치、HCO3、BE치. 기록신생인출생후1 min、5 min적Apgar평분. 약환자혈압불하강,불여처리,기록심솔급태인제혈기치,작위대조.결과 A조환자심솔감만(P<0.05),단태인제혈기분석여미급약조비교차이무통계학의의(P>0.05). B조환자심솔증쾌명현(P<0.05),악심구토발생솔고(P<0.05),차제혈기분석pH치、HCO3 치、BE치명현강저(P<0.05). C조심솔교위평은. 기중C2조심솔、혈압경위은정,수연HCO3 치교미급약조차이유통계학의의( P<0.05),단교B조유우세(P<0.05). 태인면출후Apgar평분비교차이무통계학의의. 결론 재부궁산술중,연합응용마황소화거양신상선소교단독사용기일개선혈압、심솔적효과경위량호,차대태인영향교소.
Objective To explore the effect on the parturients and newborns of combined use of ephedrine and phenylephrine in the cesarean section. Methods 200 ASAⅠ~Ⅱ patients with elective cesarean section who had no other complication were selected. The patients were randomly assigned to 5 groups,40 cases in each group. If the blood pressure decreased ( less than 20% compared with baseline,or systolic blood pressure less than 90 mmHg) ,vasopres-sors were given. Patients in group A received phenylephrine 100 μg;patients in group B used ephedrine 8 mg;patients in group C were given ephedrine and phenylephrine:group C1 received ephedrine 2 mg+phenylephrine 75 μg,group C2 used ephedrine 4 mg+phenylephrine 50 μg,group C3 received ephedrine 6 mg+phenylephrine 25 μg. The patients′blood pressure,heart rate,as well as the frequency and total dose of the vasopressors,the incidences of tachycardia and bradycardia,the dosage of atropine, the rates of maternal nausea, vomiting and other adverse reactions were recor-ded. After the delivery,the umbilical artery blood samples were collected for blood gas analysis;the blood pH,PCO2 , PO2,plasma glucose,lactate,HCO3 and BE value were determined;the Apgar scores after 1 min,5 min were recor-ded. The patients whose blood pressure did not drop were given no treatment,the heart rate and fetal cord blood gas val-ues were recorded as control (group U). Results The heart rate of the patients in group A reduced (P<0.05),but there was no significant difference in fetal cord blood analysis compared with group U (P>0.05). The heart rate of the patients in group B increased significantly (P<0.05),the incidence of nausea and vomiting was higher (P<0.05), the pH,HCO3 ,BE values in fetal cord blood analysis were lower ( P<0.05 ) . The heart rate in group C was relative stable,and the heart rate and blood pressure in group C2 were more stable,although the HCO3 was lower than that of group U,it was higher than that of group B (P<0.05). There was no significant difference in Apgar score among the 5 groups ( P>0.05 ) . Conclusion Combination of ephedrine and phenylephrine is better than single use to improve the heart rate and the blood pressure in the cesarean section with little effect on the newborns.
