泵注小剂量甲氧明在高血压患者俯卧位腰椎手术中的应用  

Application of continuous intravenous injection of low-dose methoxamine in patients with hypertension undergoing lumbar surgery in prone position

作　　者：王琳[1] 陈丽[2] WANG Lin;CHEN Li(Department of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,Second Hospital of Shanxi Medical University)

机构地区：[1]山西医科大学麻醉学系,太原030001 [2]山西医科大学第二医院麻醉科

出　　处：《山西医科大学学报》2018年第7期866-870,共5页Journal of Shanxi Medical University

摘　　要：目的研究泵注小剂量甲氧明是否能减少高血压患者俯卧位后低血压的发生。方法选择择期全麻下行俯卧位腰椎PLIF手术的高血压患者40例,随机分成对照组和试验组各20例。两组患者在全麻诱导前均进行适当的补液扩容,改为俯卧位后静脉持续泵注丙泊酚和瑞芬太尼维持麻醉。试验组在俯卧位后开始泵注甲氧明,剂量1.5-2μg/(kg·min),泵注30 min;对照组俯卧位后收缩压下降低于100 mm Hg时,给予静注麻黄碱6 mg纠正。分别记录麻醉前(T_0)、诱导后2 min(T_1)、俯卧位前(T_2)、俯卧位后(T_3)、俯卧位后5 min(T_4)、俯卧位后10 min(T_5)、俯卧位后15 min(T_6)、俯卧位后20 min(T_7)、俯卧位后25 min(T_8)、俯卧位后30 min(T_9)、俯卧位后45 min(T_10)、俯卧位后60 min(T_11)的血压和心率。术中若出现心率<50次/min,给予阿托品0.5 mg纠正。试验观察结束时总结患者使用麻黄碱和阿托品的次数及总量,麻醉药物用量、补液量、失血量和尿量。结果两组患者的一般资料包括性别、年龄、BMI、高血压病史等比较,差异无统计学意义。与麻醉前相比,两组患者俯卧位后的血压、心率均明显下降,差异有统计学意义。与对照组相比,试验组俯卧位后10,20,25,30,45 min时的血压均明显升高,差异有统计学意义。两组患者的心率变化无明显差异。两组患者人均使用麻醉药物剂量、补液量、出血量和尿量比较,差异无统计学意义。对照组共使用麻黄碱35次,总量为210 mg,试验组使用麻黄碱1次,共6 mg,两组均未使用阿托品。结论俯卧位后泵注小剂量甲氧明1.5-2μg/(kg·min),持续30 min,可有效减少高血压患者俯卧位后低血压的发生,且对心率无明显影响。Objective To investigate whether continuous intravenous injection of low-dose methoxamine could reduce the incidence of hypotension in patients with hypertension under general anesthesia in prone position for lumbar spine surgery.Methods Forty patients with hypertension undergoing lumber PLIF surgery under general anesthesia were randomly divided into two groups:control group(n=20)and experiment group(n=20).After prone position,patients were given continuously intravenous injection of 1.5-2μg/(kg·min)methoxamine for 30 min in experiment group.In control group,patients were given ephedrine 6 mg if the systolic blood pressure was lower than 100 mmHg after prone position.The blood pressure and heart rate in the two groups were recorded before induction(T 0),2 min after induction(T 1),before prone position(T 2),after prone position(T 3),5 min after prone position(T 4),10 min after prone position(T 5),15 min after prone position(T 6),20 min after prone position(T 7),25 min after prone position(T 8),30 min after prone position(T 9),45 min after prone position(T 10)and 60 min after prone position(T 11).Atropine 0.5 mg was given if HR<50 times per minute.At the end of the experiment,the times and total amount of ephedrine and atropine were summarized,as well as the dosage of anesthetic,fluid infusion,blood loss and urine volume.Results There was no significant difference in gender,age,BMI,history of hypertension between the two groups.Compared with pre-anesthesia,MBP and HR in the two groups decreased significantly after prone position.Compared with control group,MBP in experiment group was significantly higher at 10,20,25,30,45 min after prone position.There was no significant difference in HR between the two groups.There was no significant difference in the dose of anesthetic,fluid rehydration,blood loss and urine volume between the two groups.Totally 210 mg ephedrine(35 times)was used in control group,and 6 mg ephedrine(one time)was used in experiment group,and atropine was not used in two groups.Conclusion In patie

关 键 词：甲氧明 高血压 俯卧位 全身麻醉 血流动力学 

分 类 号：R614[医药卫生—麻醉学]