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제왕절개술을 위한 척수마취 시 Ephedrine과 Phenylephrine 단독 혹은 혼합 주입법이 산모와 태아에 미치는 영향
윤희조,지영석,이인호,김수미,장창하 대한마취통증의학회 2009 Anesthesia and pain medicine Vol.4 No.2
Background: Hypotension following spinal anesthesia for cesarean delivery can produce adverse maternal and neonatal effects. Single treatment with ephedrine does not prevent spinal anesthesiainduced hypotension and phenylephrine alone induces severe bradycardia. However, the combined treatment of phenylephrine with ephedrine as an infusion was observed to be effective without bradycardia. Methods: Thirty-two term parturients were randomized into three groups to receive ephedrine, phenylephrine or combination infusion (group E, group P and group EP, respectively) starting with spinal anesthesia. Hemodynamic parameters, such as SBP, PR, CI, SVRI, SVI, were measured before and until 15 min after spinal anesthesia. Rescue boluses for hypotension comprised of phenylephrine 100μg. Results: There were no statistically significant differences in all hemodynamic parameters among three groups. However, 1 min Apgar score in the group E was significant lower than P group (P = 0.008). Nausea & vomiting scores, total fluid intake, phenylephrine rescues, umbilical vein pH, and 5 min Apgar scores did not show significant differences. Conclusions: Three methods are all effective to prevent hypotension following spinal anesthesia for cesarean section. However, although there was no fetal acidosis, 1 min Apgar score of ephedrine group was significantly lower than that of phenylephrine alone group.