去氧肾上腺素联合麻黄碱对剖宫产手术产妇心率变异性的影响

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摘要目的探讨去氧肾上腺素联合麻黄碱对于剖宫产手术中产妇心率变异性的影响。方法选取2016年11月～2017年6月于中国医科大学附属盛京医院行择期剖宫产手术的90例足月单胎产妇作为研究对象，ASAⅠ～Ⅱ级，根据随机数字表法将其分为三组，每组各30例。麻醉后血压下降（较基础值下降20%或收缩压低于90 mmHg）的患者给予升压药物处理。E组给予麻黄碱0.15 mg/kg；P组给予去氧肾上腺素1 μg/kg；E+P组联合用药，给予麻黄碱0.1 mg/kg和去氧肾上腺素0.5 μg/kg。分别比较各组麻醉前（T0）、蛛网膜下腔注药后1 min（T1）、血压最低点给予升压药时（T2）、给药 3 min（T3）、给药 5 min（T4）、给药 10 min（T5）的心率变异性低频功率（LF）、心率变异性高频功率（HF）和心率变异性低频与高频功率的比值（LF/HF）。采用配对t检验法，比较各组时间点（T3～T5）与各组T0的各指标，判断是否存在统计学差异。结果 E组T1～T5时间点的LF与LF/HF值明显高于T0，HF明显低于T0，差异有统计学意义（P<0.05）。P组T1～T3时间点的LF与LF/HF值明显低于T0，HF明显高于T0，差异有统计学意义（P<0.05），T4、T5时间点的 LF、HF 和 LF/HF 与 T0比较，差异无统计学意义（P>0.05）。E+P 组 T3～T5时间点的 LF、HF和LF/HF与T0比较，差异无统计学意义（P>0.05）。E组的T3、T4的LF和LF/HF值均明显高于E+P组，HF明显低于E+P组，差异有统计学意义（P<0.05）。E组T5的LF值明显高于E+P组，HF明显低于E+P组，差异有统计学意义（P<0.05）。P组T3的LF和LF/HF值明显低于E+P组，HF明显高于E+P组，差异有统计学意义（P<0.05）。结论对于剖宫产手术的产妇，去氧肾上腺素与麻黄碱联合用药可以维持其自主神经交感/迷走的平衡，将LF、HF和LF/HF维持在正常状态，有益于心率变异性的稳定。

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关键词 ：心率变异性, 频域分析, 时域分析, 麻黄碱, 去氧肾上腺素, 妊娠期高血压, 剖宫产

Abstract：Objective To investigate the effect of Phenylephrine combined with Ephedrine on heart rate variability(HRV)during cesarean section in puerperae.Methods Ninety full-term single-birth puerperae in ASAⅠ-Ⅱ patients undergoing cesarean section in appropriate time from November 2016 to June 2017 in our hospital were enrolled.They were randomly divided into 3 groups according to the random number table method,with 30 cases in each group.Patients with reduced blood pressure after anesthesia(20%reduction from baseline or systolic blood pressure<90 mmHg)were treated for elevating blood pressure.The 0.15 mg/kg Ephedrine was provided in E group.And 1 μg/kg Phenylephrine was used in P group.In E+P group,Ephedrine(0.1 mg/kg)and Phenylephrine(0.5 μg/kg)were combined used.The HRV low frequency(LF),HRV high frequency(HF),and LF/HF were recorded before anesthesia(T0),1 min after injection into the subarachnoid space (T1),and at the lowest blood pressure using drugs for elevating blood pressure(T2),and 3 min(T3),5 min(T4),and 10 min(T5)after medication.By paired t-test,the indexes at T3-T5were compared with those at T0in order to determine whether there was a statistical difference.Results The values of LF and LF/HF at T1-T5time points in the E group were significantly higher than those at T0,and HF was significantly lower than T0,the differences were statistically significant(P<0.05).In the P group,the values of LF and LF/HF at T1-T3time points were much lower than those at T0and HF were greatly higher than T0,which was displayed statistical significance (P<0.05).In the P group,there was no sig-nificant difference in the values of LF,HF and LF/HF at T4and T5time points in the P group compared with T0(P>0.05).No significant difference in the values of LF,HF and LF/HF at T3-T5time points compared with T0in the E+P group (P>0.05).The LF and LF/HF at T3and T4time points in the E group were greatly higher than those in the E+P group,HF was significantly lower than that in the E+P group,and the differences were statistically significant(P<0.05).The LF at T5time points in the E group was greatly higher than that in the E+P group,HF was significantly lower than that in the E+P group,and the differences were statistically significant(P<0.05).The LF and LF/HF at T3time points in the P group were greatly higher than that in the E+P group,HF was significantly lower than that in the E+P group,and the differences were statistically significant(P<0.05).Conclusion For puerperae undergoing cesarean section,Phenylephrine combined with Ephedrine can maintain autonomic sympathetic/vagal balance and keep LF,HF,and LF/HF in normal conditions,which is beneficial to the HRV stability.

Key words： Heart rate variability Frequency domain analysis Time domain analysis Ephedrine Phenylephrine Gestational hypertension Cesarean section

基金资助:辽宁省自然科学基金项目（2014021023）

通讯作者: 董有静（1967-），男，辽宁沈阳人，博士，主任医师，研究方向：妇产科手术麻醉

作者简介: 朱美琳（1993-），女，江苏兴化人，中国医科大学2016级在读研究生，研究方向：妇产科手术麻醉

引用本文:

朱美琳;郑文慧;程莉莉;张婷婷;董有静. 去氧肾上腺素联合麻黄碱对剖宫产手术产妇心率变异性的影响[J]. 中国当代医药, 2018, 25(20): 117-120转124.
ZHU Mei-lin;ZHENG Wen-hui;CHENG Li-li;ZHANG Ting-ting;Dong You-jing. Effect of Phenylephrine combined with Ephedrine on heart rate variability in puerpera undergoing cesarean section. 中国当代医药, 2018, 25(20): 117-120转124.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2018/V25/I20/117

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