Effects Of Low-dose Continuously Infusing Phenylephrine On The Hemodynamics Of Cesarean Section And The Apgar Score Of Neonatal During Spinal-Epidural Anesthesia

Object: This study compared differences of continuously infusing a low-doseof Phenylephrine with inputting conventional liquid on the circulatoryindications of maternal and the state of neonatal during spinal-epiduralanesthesia, thus providing a theoretical basis for the circulationmanagement in cesarean section.Methods:43pregnant women, ASAI-II aged20-40years old,weighted50-90kg.women with circulation、respiratory、hematological、endocrine、hepatorenal disease、 pregnancy complications and contraindications tospinal anesthesia were excluded. All patients were randomly assignedinto two groups: control group (conventional liquid group) andexperimental group(phenylephrine experiment group).Control group hada conventional rehydration during Spinal-Epidural Anesthesia until theend of surgery. Experimental group matain intravenous access withcrystals liquid. When there were a downturn in BP,phenylephrine at6μg/kg/h was pumped, then adjusted the rate of phenylephrine in linewith the circulation indications.The two groups were given2ml2%Lidoin subarachnoid by5s/ml to avoid the high range of rapid injectionspeed.Then made these pregnant women in supine position.Observedindicators：the systolic blood pressure(SBP)、diastolic blood pressure (DBP)、mean arterial pressure (MAP)、heart rate (HR)、stroke volume(SV) cardiac output (CO) thoracic fluid content (TFC) accelerationindex(ACI) systemic vascular resistance (SVR) of5minutes ofentering in the operating room (T0)、5minutes afteradministration(T1)、10minutes after administration(T2)、at the time ofskin incision(T3)、at the cutting uterus (T4)、fetus removed (T5)、5minutes after fetus removed (T6)、10minutes after removal (T7)、 theend of surgery(T8) and record neonatal Apgar score.Result: When compared within groups of MAP, two groups were lower than T0ateach time point,but the differences were not statistically significant.When compared MAP between groups, the control group was higher thanthe experimental group and P<0.05, the difference was statisticallysignificant. When compared within groups of HR, the control group waslower than T0at each point.But P>0.05, the differences was notstatistically significant. When comparing the HR of the experimentalgroup in T3、T4、T8to T0, there was significantly reduced and P <0.05,the difference was statistically significant. When comparing HR betweengroups, the control group was higher than the experimental group andP<0.05, the difference was statistically significant. When compared withthe SV, the control group was higher than T0at each time point. But thedifference was not statistically significant. The experimental group washigher than T0in T5、T6、T7、T8and P <0.05, the difference wasstatistically significant. When comparing the SV between the two groupsat T4, the control group was higher the the experimental group, and P<0.05, the difference was statistically significant. When comparing the COwithin group, the control group was higher than T0at T5and P <0.05,the difference was statistically significant. When comparing the CObetween two groups, the control group was higher than the experimentalgroup, and P <0.05, the difference was statistically significant. The changeof ACI within group were consistent with the CO. When comparing the ACI between two groups, the control group was higher than theexperimental group at T2and T4, and P <0.05, the difference wasstatistically significant. When comparing the SVR, the two groups at eachtime point were lower than T0and P <0.05the difference was statisticallysignificant. When comparing the SVR between two groups, the controlgroup was higher than the experimental group at T6and there wasstastical significance. The difference was statistically significant whencomparing the amount of fluid between two groups. When comparing theTFC, the differences were not statistically significant anyway. Whencomparing the Apgar between two groups,there was no difference.Conclusion: During cesarean section anesthesia, in spite of using large amounts ofliquid could prevent and treat the hypotension of Spinal-EpiduralAnesthesia, it can increase the SV、 the CO and the burden on the heartat the same time. Low-dose continuously infusing Phenylephrine cancure the low blood pressure、cut down the heart rate and reduce the COto own a circulation stability.