持续输注小剂量去氧肾上腺素（phenylephrine）对硬膜外麻醉下剖宫产产妇血流动力学的影响
目的：探讨去氧肾上腺素和胶体在处理硬膜外麻醉下剖宫产术中低血压时维持循环的稳定和对产妇心功能的影响。为去氧肾上腺素在产科麻醉中提供新的理论依据。方法：选择ASAⅠ-Ⅱ级择期足月妊娠患剖宫产者,年龄20-40岁之间,体重53-85kg。将其随机分为两组每组18例：胶体组(1组)患者和去氧肾上腺组(2组)患者,所有患者无合并妊高症,无心、肝、肾疾病,无神经系统及内分泌病史,无硬膜外麻醉禁忌患者。第1组给维容500ml作为负荷量,于20分钟内输完,之后按10ml/kg·h维持输注。通过硬膜外导管给予实验量2%利多卡因5ml,观察各项监测指标变化,待出现麻醉平面或确定硬膜外导管在椎管内后,给予追加量2%利多卡因15ml-20ml。第2组一般在血压有下降趋势后先以6ug/kg.h泵入。根据血压及其他循环指标变化情况,控制输注胶体速度和去氧肾上腺素的量。分别于入室后5分钟(T1)、试验量5分钟(T2)、切皮时(T3)、切开子宫时(T4)、胎儿取出时(T5)、胎儿取出后5分钟(T6)、取出后10分钟(T7)和手术结束时(T8)等各时点记录给收缩压(SBP)、平均动脉压(MAP)、心率(HR)、心输出量(CO)、每搏搏出量(SV)、胸腔液体量(TFC)、加速指数(ACI)、外周血管阻力(SVR)、左心室做功(LW)的数据。结果：两组患者的心率(HR)有不同趋势的变化,第1组患者的心率逐渐升高,第2组患者心率(HR)逐渐下降,两组心率(HR)在T7T8时p0.05。左心室做功和心肌耗氧量关系密切,两组的这两个指标都在T4T5T7T8时点P都小于0.05,完全一致。结论：产科麻醉时,大量液体扩容虽然有效预防椎管内麻醉低血压的发生,但明显增加心率,心排血量,加重了心脏负担,心脏做功和心肌耗氧量大大增加。而术中选用去氧肾上腺素治疗术中低血压,可以很好的维持循环稳定,同时减少心脏做功,减少心肌耗氧量,对心脏更有利。 Object:The aim of study is to investigate the effects of Phenylephrine and colloid for preventing hypotension on cardiac function during epidural anesthesia for cesarean section. To provide a new theoretical basis for the phenylephrine in obstetric anesthesia.Methods:we recruited 36 women of ASA physical status ⅠandⅡwith term singleton pregnancies scheduled for elective cesarean delivery under epidural anesthesia. Patients with preexisting or pregnancy-induced hypertension, cardiovascular or cerebrovascular disease, known fetal abnormalities, or contraindications to epidural anesthesia were excluded. all patients aged between 20-40 years old and weight 53-85kg were randomly divided into two groups (18 cases in each group):colloid group (group 1) patients and Phenylephrine group (group 2) patients, it has been infused the preload capacity as a 500ml capacity to Group 1 within in 20 minutes, then followed according to 10ml*kg·h-1 maintenance infusion. Experimentally, by using 2% lidocaine 5ml through the epidural catheter we check the changes in the monitoring indicators, then we make sure the effect of anesthesia or the epidural catheter in the cavum epidurale, to give an additional amount of 2% lidocaine 10--15ml. Group 2 general was pumped Phenylephrine at 6μg*kg-1 h-1 after downward trend in blood pressure. According to blood pressure and other circulation indices changing, we control the speed of phenylephrine and the amount of colloid infusion. we recorded all of these following data:the systolic blood pressure (SBP), mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), stroke stroke volume (SV), thoracic fluid content (TFC), acceleration index (ACI), systemic vascular resistance (SVR) and the left ventricular acting (LW) in the following time respectively:5 minutes after entering the operating room (T1),5 minutes after testing dose (T2), at the time of skin incision (T3), the uterine incision (T4), the fetus removed (T5),5 minutes after fetus removed (T6),10 minutes after removal (T7) and surgical end (T8).Result:Two groups of patients with heart rate (HR) have different trends, group 1 patients gradually increased heart rate, heart rate in group 2 (HR) decreased in the T7T8 and has statistically significance(p 0.05).Left ventricular doing work and myocardial oxygen consumption are closely related in two groups, at T4、T5、T7、T8 points P is less than 0.05, consistently.Conclusion:In obstetric anesthesia, although a large number of liquid effectively prevent expansion hypotension during spinal anesthesia, but significantly increased heart rate, cardiac output, increased the burden on the heart, cardiac work and myocardial oxygen consumption of the large increase. The use of phenylephrine in the treatment of hypotension during operation could maintain a good cycle stability and reducing cardiac work, reducing myocardial oxygen consumption, will be more beneficial to the heart. 关键词：去氧肾上腺素|心功能|心肌耗氧|产科麻醉 |
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发表于 2012-4-14 19:40:06
发表于 2012-4-16 19:53:24
