预防性输注NE和PE对蛛网膜下腔阻滞下行髋关节骨折老年患者血流动力学的影响  

作　　者：杨慧芳[1] 陈苑[1] 周慧 程远[1] 孙建良[1] 

机构地区：[1]杭州市第一人民医院,310006

出　　处：《浙江临床医学》2023年第10期1535-1537,1540,共4页Zhejiang Clinical Medical Journal

基　　金：杭州市科技发展计划项目(20180533B36)。

摘　　要：目的比较预防性输注去甲肾上腺素(NE)和去氧肾上腺素(PE)对蛛网膜下腔阻滞下行髋关节骨折老年患者血流动力学的影响。方法选择≥60岁、美国麻醉医师协会分级(ASA)I或II级择期蛛网膜下腔阻滞下行髋关节骨折老年患者62例,采用随机数字表法分为去甲肾上腺素组(NE组,浓度为8µg/min),去氧肾上腺素组(PE组,浓度为100µg/min),每组各31例。蛛网膜下腔阻滞后两组均输注血管收缩药物,初始输注速度NE组为1 mL/min(4 mg NE与0.9%氯化钠溶液稀释至500 mL,浓度为8µg/ml)。PE组为1 mL/min(10 mg PE与0.9%氯化钠溶液稀释至100 mL,浓度为10 mg/mL)。监测围术期心率、血压、心输出量、蛛网膜下腔阻滞后低血压、心动过缓及高血压等的发生情况。结果62例患者纳入研究,每组各31例,平均年龄(71±6)岁。NE组较PE组心率更快,心输出量更高。NE组较PE组心动过缓发生率低(10%VS.36%,P=0.031),高血压发生率低(3%VS.36%,P=0.003)。患者均无低血压,平均动脉血压组间无明显差异。结论NE和PE均能有效降低髋关节骨折老年患者行蛛网膜下腔阻滞后诱发的低血压发生率,但NE组心率、心输出量更稳定,且心动过缓和高血压发生率更低。Objective To compare the hemodynamic effects of prophylactic infusion of norepinephrine(NE)versus phenylephrine(PE)in elderly patients undergoing hip fracture surgery under spinal anesthesia.Methods 62 Patients scheduled for hip fracture surgery under spinal anesthesia with a age of 60 years above and American Association of Anesthesiologists Classification(ASA)grade I or II were randomly divided into two groups:the NE group(n=31)and the PE group(n=31).The NE group received NE infusion(8μg/min)and the PE group received PE infusion(100μg/min)after spinal anesthesia.The initial infusion velocity of the NE group was 1 mL/min(4 mg NE with 0.9%sodium chloride solution was diluted to 500 mL of 8μg/ml).The PE group was 1 mL/min(10 mg PE with 0.9%sodium chloride solution was diluted to 100 mL at a concentration of 10 mg/mL).Monitored the occurrence of perioperative heart rate,blood pressure,cardiac output,hypotension,bradycardia,and hypertension after subarachnoid block.Results Sixty-two patients were included in the study,including 31 patients in each group,with a mean age(71±6)years.The NE group showed a higher mean heart rate and cardiac output than the PE group.The NE group had a lower incidence of reactive bradycardia(10%VS.36%,P=0.031)and hypertension(3%VS.36%,P=0.003)than the PE group.None of the patients had hypotension and mean arterial BP was no significantly different between the groups.Conclusion Both NE and PE infusions effectively prevent spinal anesthesia-induced hypotension in elderly patients undergoing hip fracture surgery.However,However,the NE group has a more stable heart rate and cardiac output,and a lower incidence of bradycardia and hypertension.

关 键 词：髋关节骨折 去甲肾上腺素 去氧肾上腺素 蛛网膜下腔阻滞 低血压 

分 类 号：R743.35[医药卫生—神经病学与精神病学]