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摘要：
目的: 探讨不同剂量去氧肾上腺素预防性泵注对腰麻下择期剖宫产产妇血流动力学参数、恶心呕吐发生率的影响。
方法：择期剖宫产产妇150例，采用随机数字表法将产妇分为六组（n=25）： P1～P4(去氧肾上腺素预防性泵注组)、C（对照组）、E（麻黄碱预防性静注组），腰麻完成平卧后P1～P4组产妇分别即刻以0.1、0.2、0.3、0.4μg·kg-1·min-1速度静脉泵注去氧肾上腺素10min。C组无预处理。E组平卧后即刻静脉注射麻黄碱10mg。采用无创血流监测仪监测产妇入室后基础值（T1）、麻醉前（T2）、麻醉后1分钟（T3）、麻醉后3分钟（T4）、麻醉后10分钟（T5）、胎儿娩出时（T6）的平均动脉压（Mean arterial pressure MAP）、心率（Heart rate，HR）、心输出量（Cardiac Output,CO）、心指数（Cardiac index,CI）、胸液水平（Thoracic Fluid Content,TFC）的变化；监测产妇术中胎儿娩出前恶心呕吐发生情况。
结果：与C、E组比较,去氧肾上腺素泵注组在T3、T4、T5时刻心率明显减慢(P<0.05)。P4组在T6时刻心率明显减慢(P<0.05)。T6时刻P1、P2、P3组MAP均低于C组与E组(P<0.05)。T6时刻P1、P2和P3组CO均高于C组(P<0.05)。
P3 、P4组升压药追加人数均低于C、E、P1、P2组(P<0.05)。P1～P4组阿托品使用频次比较无统计学差异(P>0.05)。各组高血压的发生率比较无统计学差异(P>0.05)。
P1～P4组去氧肾上腺素平均泵注时间分别为10.00±0.00 min、10.00±0.00 min、10.00±0.00 min和9.63±0.74 min,P4组输注时间短于P1～P3组(F = 2.41，p < 0.05)。
各组恶心呕吐发生情况比较发现，与E、C组相比，去氧肾上腺素泵注组恶心呕吐发生率显著降低（p < 0.05)。
结论：腰麻下行择期剖宫产术时预防性泵注去氧肾上腺素在维持血流动力学稳定、减少产妇恶心呕吐发生率方面较使用麻黄碱更有优势．0.3～0.4μg·kg-1·min-1是腰麻下行择期剖宫产术时较为恰当的去氧肾上腺素预防性泵注速度。
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Abstract: 【Abstract】 Objective To investigate the effects of prophylactic different infusion rate of phenylephrine on maternal hemodynamics associated with spinal anesthesia for elective caesarean section. Methods One hundred and fifty women having elective cesarean delivery under spinal anesthesia,ASAⅠor Ⅱ, aged 21～38 yr ,weighing 60～95 kg , randomly were divided into six groups (n=25) . P1～P4 groups (phenylephrine groups) received phenylephrine infusion respectively in rate of 0.1,0.2,0.3 and 0.4μg·kg-1·min-1 for ten minutes after spinal anesthesia. C group (control group) was not given prophylactic vasopressor. E group(ephedrine group) received prophylactic ephedrine 10mg intravenous administration after spinal anesthesia.Heart rate(HR),blood pressure( BP),thoracic fluid content(TFC),cardiac output（CO）and cardiac index (CI) were recorded by Noninvasive Heart Function Monitor(Solar 8000M) at baseline(T1),before anesthesia(T2) and respective parameters of 1 min(T3),3 min(T4), 10 min(T5) after anesthesia and delivery time (T6).Incidence of nausea and vomiting also was recorded. Results Compare with C group and E group,HR was decreased at T3,T4 and T5 in P1～P4 groups (P<0.05), HR was decreased at T6 In P4 group (P<0.05).MAP was decreased at T6 in P1,P2, P3 group(P<0.05). CO was increased at T6 in P1,P2 and P3 group（p < 0.05）.Number of used additional vasopressors in P3 and P4 group was less than C group,E group, P1 group and P2 group(P<0.05). Number of used additional vasopressors in P3 and P4 groups were less than C group,E group, P1 group and P2 group(P<0.05). Number of used atropin in P1～P4 groups were no difference(P>0.05).The incidence of hypertention in six groups were no difference(P>0.05) .The average time of phenylephrine infusion were 10.00±0.00 min,10.00±0.00 min,10.00±0.00 min and 9.63±0.74 min, respectively in P1～P4,the phenylephrine infusion time of P4 was significantly shorter than P1～P3((p < 0.05). Compare with and C group and E group, incidence of nausea and vomiting was significantly lower in P1～P4 groups (P<0.05).Conclusion Prophylactic infusion of phenylephrine was recommendable in maintaining stable hemodynamics, decreasing incidence of nausea and vomiting compared with ephdrine undergoing spinal anesthesia for elective caesarean section. 0.3～0.4μg·kg-1·min-1 was suitable infusion rate of prophylactic phenylephrine for elective caesarean section under spinal anesthesia .
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