2021 年第 6 期 第 16 卷

不同组合血管活性药物维持肺动脉高压产妇剖宫产术中血液动力学稳定的效果观察

Effects of different vasoactive drugs combinations on maintaining hemodynamic stability in parturient women with pulmonary artery hypertension during cesarean section

作者：葛彦虎白杨郇利莉刘亚光马骏

英文作者：Ge Yanhu Bai Yang Huan Lili Liu Yaguang Ma Jun

单位：首都医科大学附属北京安贞医院麻醉中心100029

英文单位：Anesthesia Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：肺动脉高压；剖宫产；血管活性药物

英文关键词：Pulmonaryarteryhypertension;Cesareansection;Vasoactivedrugs

• 摘要：

• 目的 观察在肺动脉高压产妇剖宫产术中分别应用多巴酚丁胺+去氧肾上腺素、多巴酚丁胺+麻黄素和多巴酚丁胺+去甲肾上腺素3种血管活性药物组合对维持血液动力学稳定的效果。方法 选取2018年1月至2020年6月于首都医科大学附属北京安贞医院行剖宫产的45例肺动脉高压产妇，采用随机数字表法分为A组、B组、C组，各15例。所有产妇采用硬膜外腔麻醉，麻醉后A组予多巴酚丁胺+去氧肾上腺素、B组予多巴酚丁胺+麻黄素、C组予多巴酚丁胺+去甲肾上腺素以维持术中血液动力学稳定。采集3组术中血液动力学指标，记录术中补液量、失血量、肺动脉压、心动过速和心动过缓比例、低血压次数、使用血管活性药物次数。胎儿出生时取新生儿脐动脉血检测血气分析指标。结果 麻醉后5、15 min，A组产妇心率持续降低，B组、C组心率略增高，胎儿出生时3组产妇心率均比较稳定，C组各时点心率均高于A组且低于B组，差异均有统计学意义（均P＜0.05）。麻醉后15 min、胎儿出生时B、C组产妇收缩压均高于A组［（117±6）、（120±6）mmHg（1 mmHg=0.133 kPa）比（91±5）mmHg，（122±6）、（126±6）mmHg比（117±6）mmHg］（均P＜0.05）。3组产妇术中补液量、失血量、肺动脉压比较，差异均无统计学意义（均P＞0.05）。C组产妇心动过速比例高于A组、低于B组，心动过缓比例低于A组、高于B组，差异均有统计学意义（均P＜0.05）。C组产妇术中发生低血压、使用血管活性药物次数均低于A、B组，差异均有统计学意义（均P＜0.05）。B、C组新生儿脐动脉血氧分压水平高于A组［（23±5）、（26±5）mmHg比（18±6）mmHg］（P＜0.05）。结论 肺动脉高压产妇剖宫产术中应用多巴酚丁胺联合去氧肾上腺素、麻黄素和去甲肾上腺素均可维持血液动力学稳定，其中多巴酚丁胺+去甲肾上腺素组合对产妇和新生儿更为安全。

• Objective To observe the effects of dobutamine+phenylephrine, dobutamine+norepinephrine and dobutamine+ephedrine on maintaining hemodynamic stability in parturient women with pulmonary artery hypertension during cesarean section. Methods From January 2018 to June 2020, 45 parturient women with pulmonary artery hypertension undergoing cesarean section in Beijing Anzhen Hospital, Capital Medical University were enrolled. They were randomly divided into group A, group B and group C, with 15 cases in each group. Parturient women were given epidural anesthesia, and then, group A was given dobutamine+phenylephrine, group B was given dobutamine+ephedrine and group C was given dobutamine+norepinephrine to maintain intraoperative hemodynamic stability. The intraoperative hemodynamic indexes were collected in the three groups, and the fluid supplement, blood loss, pulmonary artery pressure, tachycardia and bradycardia ratio, hypotension times, and vasoactive drugs used times during operation were recorded. The umbilical artery blood of the newborn was taken at the time of birth to detect the indicators of blood gas analysis. Results At 5 and 15 min after anesthesia, heart rate in group A of parturient women continuously decreased, that in group B and group C slightly increased, and that was stable in three groups at birth, while that at each time point in group C was higher than that in group A and lower than that in group B(all P<0.05). At 15 min after anesthesia and at birth, systolic blood pressure levels in group B and group C of parturient women were higher than those in group A ［（117±6）,（120±6）mmHg vs （91±5）mmHg;（122±6）,（126±6）mmHg vs （117±6）mmHg］（both P<0.05）. There were no significant differences in fluid supplement, blood loss, pulmonary artery pressure during operation among the three groups (all P>0.05). The rate of tachycardia in group C was higher than that in group A while lower than that in group B, and the rate of bradycardia in group C was lower than that in group A while higher than that in group B(all P<0.05). The times of hypotension and vasoactive drugs use during operation in group C were lower than those in group A and group B (all P<0.05). The partial pressure of oxygen in neonatal umbilical artery blood in group B and group C was higher than that in group A ［（23±5），（26±5）mmHg vs （18±6）mmHg］（P＜0.05）. Conclusions  All dobutamine combined with phenylephrine, ephedrine and norepinephrine can maintain hemodynamic stability in parturient women with pulmonary artery hypertension during cesarean section. Dobutamine+norepinephrien is helpful for maternal and neonatal safety.