高脂血症因素对硬膜外阻滞患者麻黄碱升压效应的影响  

Influence of hyperlipidemia factor on ephedrine-treated hypotension in patients undergoing epidural anesthesia

作　　者：胡雅娟[1] 刘贵德 于建设[1] Hu Yajuan;Liu Guide;Yu Jianshe(Department of Anesthesiology,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China;Department of Anesthesiology,Zhuhai People's Hospital,Zhuhai 519000,Guangdong Province,China)

机构地区：[1]内蒙古医科大学附属医院麻醉科,呼和浩特市010050 [2]珠海市人民医院麻醉科,519000

出　　处：《中华麻醉学杂志》2018年第7期797-799,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价高脂血症因素对麻黄碱治疗硬膜外麻醉并发低血压效应的影响.方法拟在硬膜外阻滞下择期子宫切除术患者,根据空腹血脂水平分为2组:正常血脂组和高脂血症组.补充累计体液损失量后行L1,2硬膜外阻滞,收缩压降至基础水平的80%以下或<90 mmHg,定义为低血压反应.麻黄碱给药后90 s内收缩压升至基础水平90%以上或>100 mmHg,定义为升压有效.静脉注射麻黄碱的起始剂量0. 10 mg∕kg,采用序贯法确定随后的剂量,相邻剂量差为0. 02 mg∕kg,升压有效时下一例患者采用低一级剂量,否则采用高一级剂量.采用概率单位回归法确定麻黄碱升压效应的半数有效剂量( ED50)及其95%可信区间(95%CI).结果 纳入试验的患者共114例,正常血脂组64例,高脂血症组50例;硬膜外阻滞诱发低血压反应率,正常血脂组22%(14例),高脂血症组40%(20例),差异有统计学意义(P<0. 05).正常血脂组和高脂血症组麻黄碱升压效应的ED50及其95%CI分别为0. 81(0. 75~1. 03)和1. 14(1. 05~1. 31) mg∕kg,差异有统计学意义(P<0. 05).结论对于女性低位硬膜外麻醉患者,高脂血症不仅可作为硬膜外阻滞并发低血压的危险因素,还可明显降低麻黄碱的升压效应.Objective To evaluate the influence of hyperlipidemia factor on ephedrine-treated hy-potension in the patients undergoing epidural anesthesia.Methods Patients scheduled for elective hysterectomy with epidural anesthesia,were divided into normal blood lipid group and hyperlipidemia group ac- cording to the fasting blood lipid level.Epidural puncture was performed at L1,2 after replacing the cumulative body fluid loss.The hypotensive response was defined as decrease in systolic pressure (SP)<80%of the baseline value or SP<90 mmHg.Effective pressor response was defined as increase in SP>90%of the baseline value or SP>100 mmHg.The initial dose of ephedrine was 0.10mg/kg.Up-and-down sequential allocation was used to determine the dose of ephedrine.The difference between two successive doses was 0.02 mg/kg.Each time the dose increased/decreased in the next patient according to whether SP increased or not. Probit analysis was used to determine the ED50,and 95%confidence interval (CI)of ephedrine in treating hypotension.Results A total of 114patients were enrolled in this study,with 64cases in normal blood lipid group and 50cases in hyperlipidemia group.The rate of epidural anesthesia-induced hypotension was 22%(14cases)in normal blood lipid group and 40%(20cases)in hyperlipidemia group,and there was significant difference between two groups (P<0.05).The ED50(95%CI)of ephedrine in treating hypotension was 0.81(0.75-1.03)mg/kg and 1.14(1.05-1.31)mg/kg in normal blood lipid group and hyperlipidemia group,respectively,and there was significant difference between two groups (P<0.05).Condusion Hyperlipidemia can not only be considered as a risk factor for epidural anesthesia-induced hypotension,but also markedly decease pressor responses to ephedrine for the female patients undergoing low epidural anesthesia.

关 键 词：高脂血症 麻黄碱 麻醉 硬膜外 低血压 

分 类 号：R614[医药卫生—麻醉学]