桂雪梅　叶小飞　周慧　宗斯　林敏　李斌　刘雨晴　周倩倩

【摘要】 目的：研究去氧肾上腺素联合体位控制剖宫产术中仰卧位综合征发生的临床效果。方法：选择2017年2-11月在本院选择剖宫产手术的300例足月孕妇，通过随机数字表法将患者平均分为A、B和C组，每组100例。A组产妇麻醉成功后选取平卧位，B组产妇麻醉成功后将产妇平卧位，在产妇右髋部垫一个沙袋，使子宫向左侧倾斜15°～30°，C组产妇麻醉成功后即刻静脉泵注小剂量去氧肾上腺素，同时在产妇右髋部垫一个沙袋，使子宫向左侧倾斜15°～30°，比较三组产妇麻醉前后的收缩压（SBP）、舒张压（DBP）、心率（HR）状态、新生儿的Apgar评分以及仰卧位综合征的发生率。结果：麻醉前后，C组产妇的SBP、DBP及HR比较，差异均无统计学意义（P>0.05）。麻醉前后，B组和A组T2、T3的SBP与DBP均低于T1，T2、T3的HR均高于T1，差异均有统计学意义（P<0.05）。B组和A组产妇的SBP、DBP及HR比较，差异均有统计学意义（P<0.05）。C组中新生儿出生1 min后的Apgar评分明显高于B组和A组，差异均有统计学意义（P<0.05）；三组新生儿出生5 min后的Apgar评分比较，差异无统计学意义（P>0.05）；C组仰卧位综合征发生率为1%，显著低于B组的35%和A组的45%，差异均有统计学意义（P<0.05）。结论：静脉泵注小剂量去氧肾上腺素联合体位改变能有效控制剖宫产术中仰卧位综合征的发生，更好的维持产妇血流动力学的稳定，对新生儿Apgar评分的提升也有着积极的作用，值得临床推广。

【關键词】 去氧肾上腺素； 仰卧位综合征； 剖宫产； 腰硬联合麻醉

Clinical Effect of Phenylephrine Combined with Postural Control on Supine Syndrome in Cesarean Section/GUI Xuemei，YE Xiaofei，ZHOU Hui，et al.//Medical Innovation of China，2018，15（06）：130-133

【Abstract】 Objective：To study the clinical effect of Phenylephrine combined with position control supine syndrome in cesarean section.Method：A total of 300 full-term pregnant women who underwent cesarean section in our hospital from February 2017 to November 2017 were randomly divided into group A，group B and group C，

100 cases in each group.Group A chose supine position was selected after successful anesthesia，group B chose supine position of parturient after successful anesthesia，and pad a sandbag in the maternal right hip，so that the uterus tilted to the left by 15°～30°，in group C，a small dose of Phenylephrine was injected immediately after anesthesia，and a sandbag was put on the right hip of the parturient，so that the uterus tilted to the left by 15°～30°.Systolic blood pressure（SBP），diastolic blood pressure（DBP），heart rate（HR），neonatal Apgar scores and supine syndrome were compared between the three groups before and after anesthesia.Result：Before and after anesthesia，the SBP，DBP and HR of group C did not fluctuate significantly with significance（P>0.05）.Before and after anesthesia，the SBP and DBP of T2，T3 in group B and group A were lower than those at T1，and T2，T3 were higher than those at T1，the differences were statistically significant（P<0.05）.The Apgar score of newborns in group C at 1 min after birth was significantly higher than those in group B and group A（P<0.05），the Apgar scores of newborns at 5 min after birth in the three groups were not significant（P>0.05）.The incidence of supine syndrome in group C was 1%，which was significantly lower than 35% and 45% in group B and group A，

the differences were statistically significant（P<0.05）.Conclusion：Intravenous infusion of small doses of Phenylephrine combined with body position changes can effectively control the occurrence of supine syndrome in cesarean section and better maintain the hemodynamic stability of the maternal and neonatal Apgar score also has a positive role，it is worth clinical promotion.

【Key words】 Phenylephrine； Supine syndrome； Cesarean section； Combined spinal-epidural anesthesia

First-authors address：Jiujiang City Maternal and Child Health Hospital，Jiujiang 332000，China

doi：10.3969/j.issn.1674-4985.2018.06.037

剖宫产手术中一种较为严重的合并症就是仰卧位综合征[1]，这种合并症产生的原因是在妊娠期仰卧位时，由于下腔的靜脉受到压迫，造成回流的减少，导致血压的下降[2]，进而造成急性胎儿宫内的窘迫以及新生儿的窒息状况，严重时可能会危及孕妇和婴儿的生命[3]。去氧肾上腺素自身有较小的毒性，是一种类似肾上腺素的药物，其有良好的升压效果，而且能够长时间发挥作用[4-5]。去氧肾上腺素能够对孕妇的低血压产生防治作用，而且还能够有效降低胎盘相关血管阻力，对血流灌注起到改善作用[6]。为……