摘要
目的探讨不同速度甲氧明静脉恒速泵注对腰硬联合麻醉剖宫产患者血流动力学的影响。方法选择择期腰硬联合麻醉下行剖宫产患者,按不同速度甲氧明静脉恒速泵注[2、3、4μg/(kg·min)]随机分为3组,即M2组、M3组、M4组。2min后蛛网膜下腔给予0.5%布比卡因2 ml。在入室(T1)、穿刺前(T2)、穿刺后1 min(T3)、3 min(T4)、5 min(T5)、10 min(T6)、15 min(T7)、20 min(T8)各时点记录平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、心输出量(cardiac output,CO)、心指数(cardiac index,CI)和外周血管阻力(systemic vascular resistance,SVR)变化;记录新生儿1 min和5 min的Apgar评分,患者恶心呕吐、高血压发生情况和单次追加甲氧明和阿托品的情况。结果 65例患者纳入本研究,3组患者年龄、体重、体表面积(body surface area,BSA)、麻醉平面等差异均无统计学意义(P>0.05);各组内不同时间点之间MAP的差异有统计学意义(P<0.05)。同一时点各组间比较,M4组在T3、T4、T6时刻MAP高于M2组,M3组在T4时刻高于M2组(P<0.05);各组内不同时间点之间HR的差异有统计学意义(P<0.05)。同一时点各组间比较,M4组在T5、T7时刻HR显著低于M2组(P<0.05);3组间CO、CI比较差异无统计学意义;各组间SVR比较,M4组在T3、T4、T5时刻高于M2组,在T5、T7时刻高于M3组(P<0.05);3组新生儿1 min、5 min的Apgar评分比较,差异无统计学意义(P>0.05);3组患者围术期恶心呕吐、高血压的发生率比较,差异无统计学意义(P>0.05);而甲氧明追加率、阿托品使用率的比较,差异有统计学意义(P<0.05)。结论中等速度甲氧明[3μg/(kg·min)]恒速泵注患者的血流动力学较为稳定,对CO和CI影响小,同时心动过缓发生率低,是较为理想的输注速度。
Objective To investigate the clinical effect of continuous methoxamine infusion on patients with combined spinal epidural anesthesia（CSEA） undergoing cesarean section. Methods The patients with CSEA undergoing cesarean section were randomly divided into three groups, 2,3,4 μg/（kg·min） methoxamine were infused in. When punctured into subarachnoid space, continuous infusion of methoxamine was performed immediately, then 0.5% bupivacaine 2 ml were initiated 2 min later. MAP,HR,CO,CI and SVR were recorded. Apgar scores of newborn were recorded at 1min and 5min after birth. And nausea, vomit and usage of atropine and methoxamine during operation were recorded. Results Sixty-five patients were enrolled into the study. There were no differences between the two groups in age, body weight, BSA and anesthesia level（P〉0.05）. MAP was higher in group M4 than group M2 at T3,T4 and T6, while MAP was higher in group M3 at T4 than group M2（P〈0.05）. HR was lower in group M4 than group M2 at T5 and T7（P〈0.05）.SVR was higher in group M4 than group M2 at T3,T4,T5, than group M3 at T5,T7（P〈0.05）.The patients in group M2 needed more additional methoxamine, but group M4 used more atropine（P〈0.05）. Conclusion When continuously infusion of methoxamine at 3μg/（kg·min） in patients with CSEA undergoing cesarean section, hemodynamics will be more stable, and the incidence of bradycardia is lower.
作者
刘晓鹏
权哲峰
池萍
张本厚
曹英浩
赵惠娜
Liu Xiaopeng Quan Zhefeng Chi Ping Zhang Benhou Cao Yinghao Zhao Huina(Department of Anesthesiology, Beijing You ＇an Hospital, Capital Medical University, Beijing 100069, China)
出处
《北京医学》
CAS
2016年第12期1282-1285,共4页
Beijing Medical Journal
关键词
甲氧明
腰硬联合麻醉
剖宫产
methoxamine
combined spinal epidural anesthesia（CSEA）
cesarean section
