甲氧明防治老年患者下肢骨科手术蛛网膜下腔阻滞后低血压的临床研究  

Drevention of spinal anesthesia-induced hypotension in the elderly with lower limb surgery by intramuscular methoxamine

作　　者：杨刚[1] 宋世姣 尹静[1] 胡双[1] 田春林[1] 邹学军[1] 

机构地区：[1]三峡大学仁和医院麻醉科,湖北宜昌443001

出　　处：《重庆医学》2015年第17期2359-2361,共3页Chongqing medicine

基　　金：湖北省卫生厅资助项目(JX6C27)

摘　　要：目的观察肌肉注射甲氧明防治老年患者下肢骨科手术蛛网膜下腔阻滞后低血压的临床效果。方法择期行股骨颈骨折手术的老年患者60例,分为两组（n=30）,肌肉注射甲氧明组（MX组）：麻醉前10min给予甲氧明10mg臀深部肌肉注射;对照组即预扩容组（DR组）：麻醉前20min静脉输注代斯500mL和乳酸钠林格液500mL。记录入室后60min内收缩压（SBP）、舒张压（DBP）和心率（HR）的变化。如出现低血压,予甲氧明1-2mg补救性注射。结果 DR组低血压发生率为77%,MX组为47%,组间比较差异有统计学意义（P〈0.05）;应用甲氧明补救性注射在DR组为53%,MX组为27%,两组比较差异有统计学意义（P〈0.05）;麻醉前DR组及MX组患者SBP均升高（与基础值比较）,组间比较差异无统计学意义（P〉0.05）;MX组HR下降且整个观察期均明显低于DR组。麻醉后两组SBP均明显下降（与基础值比较）,但MX组收缩压始终高于DR组。结论对于血容量正常的老年患者,在蛛网膜下腔阻滞实施前10min给予甲氧明10mg肌肉注射,可提供更加稳定的血流动力学,同时,操作便利。Objective To observe the effect of intramuscular methoxamine on preventing hypotension induced by spinal-anesthesia in the elderly with lower limb surgery.Methods Sixty elderly patients underwent femoral neck fracture surgery were randomly divided into two groups（n=30）,intramuscular methoxamine group（MX）：10minutes before anesthesia,10 mg of methoxamine was used to deep hip muscle injection;Control group（DR）：500mL of Daisi and 500 mL of sodium lactate Ringer were given in20 minutes before anesthesia by intravenous infusion.Changes of systolic blood pressure（SBP）,diastolic blood pressure（DBP）and heart rate（HR）were recorded within 60 minutes.1to 2mg of methoxamine was given if there was hypotension.Results Incidence rate of hypotension in DR group was 77%,47%for MX group,the difference was statistically significant（P〈0.05）;Usage rate of methoxamine in DR group was 53%,27%for MX group,the difference was statistically significant（P〈0.05）;In two groups,SBP increased initially from baseline.HR decreased from baseline in group MX and was significantly lower than that in group DR during the whole observation period.In the two groups,SBP significantly decreased from baseline after anesthesia,but SBP in MX group was always higher than that in group DR.Conclusion In the elderly with normal blood volume,Used 10 mg of intramuscular methoxamine in 10 minutes before subarachnoid block can provide more stable hemodynamics,it is also very convenient.

关 键 词：甲氧明 注射 肌肉内 老年患者 蛛网膜下腔出血 低血压 

分 类 号：R614[医药卫生—麻醉学]