中国妇幼保健

目的 分析不同剂量去甲肾上腺素对腰麻剖宫产产妇颈内静脉内径呼吸变异度(VIJV)的影响，为腰麻剖宫产产妇提供更稳定的血流动力学指标，改善母婴预后。方法 选取2024年12月—2025年9月在绍兴市上虞妇幼保健院进行择期腰麻剖宫产的150例产妇，按术中去甲肾上腺素给药剂量分为3组，每组50例，术中A组、B组、C组去甲肾上腺素剂量分别为0.02、0.04、0.06μg/(kg·min)。比较3组产妇的血流动力学指标、麻醉情况、VIJV、脐动脉血气分析指标、Apgar评分及不良反应。结果 麻醉后3 min、胎儿娩出时、手术结束时，A组平均动脉压(MAP)均低于B组、C组，C组心率(HR)均低于A组、B组(均P<0.05)。3组麻醉操作时间、手术操作时间、腰麻至胎儿娩出时间、留观时间比较，差异均无统计学意义(均P>0.05)。麻醉后3、10、20 min,A组VIJV分别为(32.48±4.15)%、(33.10±4.20)%、(32.85±4.64)%，均高于B组[(27.14±4.94)%、(28.82±5.17)%、(29.67±5.74)%]、C组[(26.89±5.01)%、(27.75±4.97)%、(28.51±6.20)%]，差异均有统计学意义(均P<0.05)。3组低血压发生率比较，差异有统计学意义(P<0.05)。结论 与0.02、0.06μg/(kg·min)去甲肾上腺素相比，采用0.04μg/(kg·min)去甲肾上腺素可以减少低血压的发生，通过降低VIJV维持产妇血流动力学指标稳定。

Objective To analyze the effect of different doses of norepinephrine on internal jugular vein diameter respiratory variability( VIJV) of cesarean section women under lumbar anesthesia,provide more stable hemodynamic indicators for cesarean section women,and improve maternal and infantile prognosis. Methods A total of 150 parturient women who underwent elective cesarean section under lumbar anesthesia in Shangyu Maternal and Child Health Hospital of Shaoxing from December 2024 to September 2025 were selected and divided into three groups according to the dose of intraoperative norepinephrine,with 50 cases in each group. The intraoperative norepinephrine doses in group A,group B,and group C were 0. 02,0. 04,and 0. 06 μg/( kg·min),respectively. The hemodynamic indexes,anesthesia situations,VIJV,umbilical artery blood gas analysis indexes,Apgar scores,and adverse reactions were compared among the three groups. Results At 3 minutes after anesthesia,at the time of fetal delivery,and at the end of the operation,mean arterial pressures( MAP) in group A were lower than those in group B and group C,and heart rate( HR) in group C were lower than those in group A and group B( all P<0. 05). There was no statistically significant difference in anesthesia operation time,operation time,the time from lumbar anesthesia to fetal delivery,and observation time among the three groups( all P>0. 05). At 3,10,and 20 minutes after anesthesia,VIJV in group A were( 32. 48±4. 15) %,( 33. 10±4. 20) %,and( 32. 85±4. 64) %,respectively,which were higher than those in group B [( 27. 14±4. 94) %,( 28. 82±5. 17) %,( 29. 67±5. 74) %]and group C [( 26. 89±5. 01) %,( 27. 75±4. 97) %,( 28. 51±6. 20) %],and the differences were statistically significant( all P<0. 05). There was statistically significant difference in incidence rate of hypotension among the three groups( P<0. 05). Conclusion Compared with 0. 02,0. 06 μg/( kg·min) norepinephrine,0. 04 μg/( kg·min) norepinephrine can reduce the incidence rate of hypotension,maintain the stability of maternal hemodynamic indexes by reducing VIJV.