序贯法测定去氧肾上腺素用于腰麻下剖宫产患者低血压的ED_(50)和ED_(95)  

Up-down determination of ED_(50) and ED_(95) of phenylephrine for treatment of spinal anesthesia-induced hypotension in parturients undergoing cesarean delivery

作　　者：贾真[1] 耿丽娜[1] 李作菊[1] 焦岩[1] 杨彦军[1] 

机构地区：[1]武警河南总队医院麻醉科,河南郑州450052

出　　处：《临床军医杂志》2014年第7期726-728,共3页Clinical Journal of Medical Officers

摘　　要：目的探讨腰麻致剖宫产患者低血压使用去氧肾上腺素的ED50（半数有效剂量）和ED95（95％有效剂量）。方法选择ASAI-Ⅱ级，孕37—42周，拟在腰麻下行剖宫产术的初产妇80例，于麻醉操作前按10ml／kg体质量输入林格液500—800ml。然后于左侧卧位L3-4间隙行腰麻，如果腰麻后产妇的收缩压降至基础的80％以下，或者SBP〈90mmHg（1mmHg=0．133kPa），则给予去氧肾上腺素100Ixg为试验起始剂量，下-试验对象所使用的剂量由上一试验对象对试验药物的反应决定。如产妇接受试验药物后90s内，SBP恢复至基础值的80％以上或者恢复至〉90mmHg，则该病例判定为有效，下一产妇所接受的去氧肾上腺素的剂量减少20μg。如果产妇接受试验剂量后，低血压的持续时间〉90s，则麻醉医生追加相应的去氧。肾上腺素，该病例判定为无效，下一产妇所接受的去氧肾上腺素的剂量增加20μg。结果80例产妇中接受腰麻者共计72例，其中有47例（65．3％）产妇因为腰麻引起的低血压使用了不同剂量的去氧肾上腺素，计算出的去氧肾上腺素ED50为105．9μg[95％CI（81．1，128．3）]；ED95为175．3μg[95％CI（143．8，367．4）]。结论去氧肾上腺素用于腰麻下剖宫产患者低血压的ED50为105．9μg[95％CI（81．1，128．3）]；ED95为175．3μg[95％CI（143．8，367．4）]。Objective To estimate the 50% and 95% effective dose （EDso and ED95 ） of IV phenylephrine for treatment of hypotension associated with spinal anesthesia for cesarean delivery. Methods A total of 80 gravidae （ASA I and II , 37 -42 preg- nant weeks） undergoing cesarean delivery were recruited. All the women received spinal anesthesia using hyperbaric bupivacaine （ 12.5 mg）. An up-down sequential allocation method was used to estimate the ED95 and EDs0 of phenylephrine. If the systolic blood pressure （SBP） decreased to less than 80%0 of baseline or to less than 90 mmHg （ 1 mmHg = 0. 133 kPa）, the assigned dose of phenylephrine was administered. If the SBP returned to more than 80% of baseline or more than 90 mm Hg within 1.5 rain, the case was considered a success, otherwise it was a failure. The initial dose of phenylephrine was 100 μg. Results Of the 80 subjects, 72 consented. Forty-seven （65.3%） of the enrolled subjects experienced spinal anesthesia induced hypotension and received a blinded dose of phenylephrine. Those subjects who developed hypotension received doses of phenylephrine between 80 and 160 μg. The ED50 of phenylephrine was 105.9 μg[95% CI（81.1, 128.3 ） ], and the ED95 of phenylephrine was 175.3 μg[95% CI（ 143.8, 367.4） ]. Conclusion The ED50 of phenylephrine required to treat spinal anesthesia induced hypotension in cesarean delivery is 105.9 μg[ 95 % CI （ 81.1,128.3 ） ] and the ED95 is 175.3 μg [ 95 % CI （143.8,367.4） ].

关 键 词：去氧肾上腺素 剖宫产术 半数有效剂量 

分 类 号：R972.5[医药卫生—药品]