KẾT QUẢ SỬ DỤNG NORADRENALIN VÀ EPHEDRIN DỰ PHÒNG VÀ ĐIỀU TRỊ HẠ HUYẾT ÁP DO GÂY TÊ TỦY SỐNG Ở SẢN PHỤ MỔ LẤY THAI TẠI BỆNH VIỆN ĐẠI HỌC Y HẢI PHÒNG NĂM 2024

Abstract

Background: Hypotension during spinal anesthesia for cesarean section is a very common complication that can cause serious consequences for the mother and fetus. Therefore, prevention and treatment of this complication are very important. Vasopressors recently recommended for the prevention of hypotension during spinal anesthesia for cesarean section are noradrenaline and ephedrine. Objective: Describe the results of noradrenaline and ephedrine in preventing hypotension and describe the results of noradrenaline and ephedrine in treating hypotension caused by spinal cord stimulation in women undergoing cesarean section. Subjects and Methods: Prospective comparative study. 100 pregnant women with indications for cesarean section agreed to spinal anesthesia, aged 18-35, ASA I, excluding pregnant women with pathologies during pregnancy. Pregnant women were divided into two groups: group N (Noradrenaline) and group E (Ephedrine). After spinal anesthesia for cesarean section, they were treated with bolus ephedrine and noradrenaline at doses of 5 mg (repeated up to 30 mg) and 50 µg, respectively, to prevent hypotension. Pregnant women are monitored for heart rate and blood pressure at various times (Tr0,Tr1,T0, T1, T2.5,….T60, T75, Ts1,Ts2). Both groups were recorded for the rate of hypotension, the degree of hypotension, adverse effects in mothers and neonatal APGAR index  at 1 minute and 5 minutes. Data analysis and processing on Microsoft Excel 2019, SPSS 22.0 software. Results: The reduction in hypotension due to spinal anesthesia was significant when vasopressor prophylaxis was given immediately after anesthesia. The number of hypotension episodes and the need for vasopressor injection were lower in group N than in group E (p < 0.05). The mean total amount of vasopressors used in group N was 91.4 ± 50.7 (50 - 150) μg, in group E was 12.5 ± 6.5 (5 - 30) mg. The time to onset of blood pressure raising effect in group N was 0.52 ± 0.04 minutes, lower than in group E at 0.96 ± 0.06 minutes (p < 0.05). The mean heart rate was significantly lower in group N than in group E (P < 0.05). The APGAR scores of the infants in both groups were 8 or more at 1 min and 9 or more at 5 min. Conclusion: Ephedrine 5 mg and noradrenaline 50 µg were both effective in preventing and treating hypotension after spinal anesthesia for cesarean section, however, in the noradrenaline group, tachycardia was less common and the onset of blood pressure elevation was faster than in group E. Both groups of spinal anesthesia hypotension prevention in this study did not adversely affect the Apgar score.