ERAS理念下多巴胺输注预防剖宫产腰麻后低血压的临床运用

目的研究加速康复外科(ERAS)理念下多巴胺输注预防剖宫产腰麻后低血压的临床效果。方法318例行剖宫产的产妇,以随机数字表法分为A组、B组、C组,每组106例。产妇腰麻后分别给予多巴胺,初始输注剂量为A组1μg/(kg·min)、B组3μg/(kg·min)、C组5μg/(kg·min)。比较三组一般情况、围术期并发症发生情况及用药情况、各时点收缩压(SBP)、心率(HR)变化、脐动脉血气相关数据及Apgar评分。结果最终共有300例产妇完成研究,A组100例,B组100例,C组100例。B组、C组腰麻后低血压占比(7%、5%)均低于A组(29%),C组术中高血压占比(9%)高于A组0、B组0,B组、C组多巴胺推注次数少于A组,B组阿托品用量少于A组与C组,差异有统计学意义(P<0.05)。B组、C组多巴胺推注次数比较,差异无统计学意义(P>0.05)。A组与C组阿托品用量比较,差异无统计学意义(P>0.05)。A组T₂、T₃、T₄、T₅、T₆、T₇、T₈、T₉、T₁₀、T₁₁时的SBP均低于T₀,B组T₅、T₆、T₇、T₈、T₉、T₁₀、T₁₁时的SBP低于T₀,差异均有统计学意义(P<0.05)。C组各时点SBP比较,差异无统计学意义(P>0.05)。T₄时,B组HR高于C组,差异有统计学意义(P<0.05)。除T₄外,三组产妇其他各时点HR的变化比较,差异无统计学意义(P>0.05)。A组T₈时HR低于T₀,T₁₁时HR高于T₈,B组T₄、T₅、T₆、T₇、T₈、T₉、T₁₀时HR均低于T₀,B组T₁₁时HR高于T₇、T₈、T₉,C组T₃、T₄、T₅、T₆、T₇、T₈、T₉时HR均低于T₀,C组T₁₁时HR均高于T₄、T₅、T₆、T₇、T₈、T₉、T₁₀,差异有统计学意义(P<0.05)。三组pH、血氧分压(PO₂)、二氧化碳分压(PCO₂)、乳酸、1 min Apgar评分、10 min Apgar评分比较,差异无统计学意义(P>0.05)。结论3μg/(kg·min)、5μg/(kg·min)输注速度皆能有效预防剖宫产腰麻后低血压,且3μg/(kg·min)的并发症更少。

Clinical application of dopamine infusion for preventing postspinal anesthesia hypotension during cesarean section based on ERAS concept

Objective To study the clinical effect of dopamine infusion for preventing postspinal anesthesia hypotension during cesarean delivery based on enhanced recovery after surgery(ERAS)concept.Methods A total of 318 parturients undergoing cesarean section were divided into group A,group B,and group C by random numerical table,with 106 cases in each group.After lumbar anesthesia,dopamine was administered to the parturients at an initial infusion dose of 1μg/(kg·min)in group A,3μg/(kg·min)in group B,and 5μg/(kg·min)in group C.The general conditions,occurrence of perioperative complications and medications,changes of systolic blood pressure(SBP),heart rate(HR),umbilical artery blood gas data and Apgar score at different time points of the three groups were compared.Results A total of 300 parturients completed the study in the end,with 100 cases in group A,100 cases in group B and 100 cases in group C.The percentage of hypotension after spinal anesthesia in group B(7%)and group C(5%)was lower than that in group A(29%);the percentage of intraoperative hypertension in group C(9%)was higher than that in group A(0)and group B(0);the number of dopamine injections in group B and group C was less than that in group A;the dosage of atropine in group B was less than that in group A and group C;all the differences were statistically significant(P<0.05).There was no statistically significant difference in the number of dopamine injections between group B and group C(P>0.05).There was no statistically significant difference in dosage of atropine between group A and group C(P>0.05).The SBP at T₂,T₃,T₄,T₅,T₆,T₇,T₈,T₉,T₁₀,and T₁₁ in group A was lower than that at T₀,and the SBP at T₅,T₆,T₇,T₈,T₉,T₁₀,and T₁₁ in group B was lower than that at T₀,and the differences were statistically significant(P<0.05).There was no statistically significant difference in SBP at different time points in group C(P>0.05).At T₄,the HR of group B was higher than that of group C,and the difference was statistically significant(P<0.05).Except for at T₄,there was no statistically significant difference in the HR changes of the three groups at other time points(P>0.05).In group A,HR at T₈ was lower than that at T₀,and HR at T₁₁ was higher than that at T₈;In group B,HR at T₄,T₅,T₆,T₇,T₈,T₉ and T₁₀ were all lower than that at T₀,and HR at T₁₁ was higher than those at T₇,T₈,T₉;In group C,HR of at T₃,T₄,T₅,T₆,T₇,T₈ and T₉ were all lower than that at T₀,and HR at T₁₁ was higher than those at T₄,T₅,T₆,T₇,T₈,T₉,T₁₀;all the differences were statistically significant(P<0.05).There was no statistically significant difference in pH,partial pressure of oxygen(PO₂),partial pressure of carbon dioxide(PCO₂),lactic acid,1 min Apgar score,and 10 min Apgar score among the three groups(P>0.05).Conclusion Dopamine infusion rates of 3μg/(kg·min)and 5μg/(kg·min)were both effective in preventing postspinal hypotension during cesarean delivery,and infusion rates of 3μg/(kg·min)has fewer complications.