目的 探讨预注不同剂量去氧肾上腺素对剖宫产术中大剂量布比卡因腰麻后低血压的预防作用.方法 将2015年4月至2016年2月在四川大学华西第二医院和成都市妇女儿童医学中心100例拟行择期剖宫产产妇用随机数字表法分为4组,每组各25例.行布比卡因腰麻后立即经莫菲氏管给予去氧肾上腺素50ug(Ps0组)、100ug(P100组)、150ug(P150组)和5mL生理盐水(C组).每分钟测量并记录一次收缩压(systolic blood pressure,SBP)和心率(heart rate,HR).观察低血压、心动过缓、高血压、恶心、呕吐的发生情况和新生儿1min、5min的Apgar评分及脐动脉血气分析结果.结果 4组低血压的发生率分别为84 ％(C组)、72％(Ps0组)、40％(P100组)和32％(P150组),组间比较差异有统计学意义(P＜0.05).高血压的发生率随去氧肾上腺素剂量增加而增加,P1s0组最高达到36％,组间比较差异有统计学意义(P＜0.05).心动过缓、恶心的发生率和新生儿1min、5min Apgar评分、新生儿脐动脉血气结果差异无统计学意义(P＞0.05).结论 对剖宫产产妇实施大剂量布比卡因腰麻后,预防性单次注射100ug去氧肾上腺素可以有效降低低血压的发生率.%Objective To evaluate the effects of prophylactic different doses of phenylephrine during high-dose bupivacaine spinal anesthesia for cesarean section.Methods 100 parturients scheduled for cesarean section hospitalized in West China Second Hospital affliated of Sichuan University and Chengdu Women and Children Central Hospital from April 2015 to February 2016 were randomized to receive 0.9 ％ saline 5 mL (Control Group) or phenylephrine 50ug (P50 Group),100ug (P 100 Group),or 150ug (P150Group) via murphy's dropper immediately after induction of combined spinalepidural anesthesia.Maternal blood pressure and heart rate were recorded at 1-min intervals until delivery.The incidence of hypotension,hypertension,bradycardia,nausea,and vomiting as well as Apgar scores and umbilical artery blood gases were recorded.Results The incidence of hypotension was 84 ％ in the Control Group,72 ％ in the Group P50, 40 ％ in the Group P10o and 32 ％ in the Group P150 (P ＜ 0.05).The incidence of hypertension increased as the dose of prophylactic phenylephrine increased (P ＜ 0.05) and was highest in the P150 group (37 ％).The incidence of bradycardia,nausea,and vomiting as well as Apgar scores and umbilical artery blood gases did not differ among the four groups (P ＞0.05).Conclusions Prophylactic injection of phenylephrine 100ug was a suitable alternative method for reducing the incidence of hypotension during high-dose spinal anesthesia for cesarean section.
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