硬膜外局部麻醉药物中添加去氧肾上腺素对老年患者血流动力学影响的初步研究  

A pilot study of the hemodynamic effects of phenylephrine in epidural local anesthetics in elderly patients

作　　者：赵磊[1] 王天龙[1] 肖玮[1] 郎宇[1] 

机构地区：[1]首都医科大学宣武医院麻醉科,北京100053

出　　处：《国际麻醉学与复苏杂志》2016年第8期673-677,共5页International Journal of Anesthesiology and Resuscitation

基　　金：北京市215高层次卫生技术人才学术带头人（008-0027）;北京市医院管理局“登峰计划”专项经费资助（DFL20150802）;北京市215高层次卫生技术人才学术骨干（00843093）;北京市科委“首都临床特色应用研究”专项基金（Z131107002213083）

摘　　要：目的观察硬膜外局部麻醉药物中添加去氧肾上腺素对老年患者血流动力学的影响。方法选择30例ASA分级I、Ⅱ级，择期硬膜外麻醉下进行全髋或半髋关节置换术的老年患者，按随机数字表法分为对照组和观察组（每组15例）。对照组硬膜外局部麻醉药为利多卡因（2％利多卡因17ml＋生理盐水3ml，不添加血管活性药物），观察组硬膜外局部麻醉药为添加15mg／L去氧肾上腺素的利多卡因（2％利多卡因17ml＋100mg／L去氧肾上腺素3m1）。记录硬膜外给药前1min（Tn）和麻醉后5min（T1）、15min（T2）、30min（T3）、60min（T4）及术毕时刻（T，）的HR、SBP、DBP、MAP、心排血量指数（cardiacoutputindex，CI）和每搏指数（strokevolumeindex，SVI）。记录术中麻黄碱用量。结果观察组患者麻醉期间麻黄素用量明显低于对照组[（1．5±3．2）mg比（6．4±8．6）mg]（P〈0．05），观察组患者L、T4和T5时的心脏SVI明显高于T0[分别为（35±8）、（36±9）、（36±9）m1]m^2比（31±8）ml／m^2]（P〈0．05）。结论老年患者硬膜外局部麻醉药物中添加少量去氧肾上腺素可减少硬膜外麻醉后麻黄素的用量，并可以增加心脏SVI。Objective To elarify the hemodynamie effects of phenylephrine added to loeal anesthetic during epidural analgesia in elderly patients. Methods Thirty elderly （65 y） patients who underwent elective total hip arthroplasty or semi-hip arthroplasty under epidural anesthesia were randomly divided into the eontrol and observation group （n=15）. Patients in the control group received lidoeaine （2% lidoeaine 17 ml ＋ normal saline 3 ml）, whereas those in the observation group reeeived lidoeaine plus phenylephrine （2% lidoeaine 17 ml±0.1% phenylephrine 3 ml） for epidural anesthesia. The hemodynamie parameters including heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, cardiac output index （CI）, and stroke volume index （SVI） were recorded at 1 rain （To） before and 5 rain （T1）, 15 rain （T2）, 30 rain 0＂3） and 60 rain （T4） after epidural injection and at the end of surgery （Ts）. The doses of ephedrine were recorded. Results The mean dose of ephedrine used during anesthesia was significantly lower in the observation group than in the eontrol group [（1.5＋3.2） mg vs （6.4＋8.6） mg]（P〈0.05）. When compared with To, the SVI was significantly higher at T3, T4 and T5 in the observation group [（35±8）, （36±9）, （36＋9） ml/m2 vs （31±8） m]/m^2]（p〈0.05）. Conclusions Phenylephrine, when mixed with local anesthetics, can decrease the requirement of ephedrine and increase the SVI during epidural anesthesia in elderly patients.

关 键 词：硬膜外麻醉 去氧肾上腺素 局部麻醉药 老年患者 每搏指数 

分 类 号：R614[医药卫生—麻醉学]