小剂量去甲肾上腺素预防肩关节镜手术体位改变所致低血压的效果  

Effect of Low-dose Norepinephrine in Preventing Hypotension Caused by Positional Changes during Shoulder Arthroscopy Surgery

作　　者：赵佳佳 李丽娜 张益国 张科学 ZHAO Jia-Jia;LI Li-Na;ZHANG Yi-Guo;ZHANG Ke-Xue(Anesthesiology Department of Shunyi District Hospital,Beijing 101300,China;Pediatric Surgery Department of the Seventh Medical Center of the Chinese PLA General Hospital,Beijing 100010,China)

机构地区：[1]顺义区医院麻醉科,北京101300 [2]中国人民解放军总医院第七医学中心小儿外科,北京100010

出　　处：《中国药物经济学》2025年第3期69-72,76,共5页China Journal of Pharmaceutical Economics

基　　金：解放军总医院“3+1”创新人才建设工程青年科技英才基金资助项目(20230429)。

摘　　要：目的探讨小剂量去甲肾上腺素预防沙滩椅位(BCP)下肩关节镜手术全身麻醉患者体位改变所致低血压的效果。方法选取顺义区医院2023年12月至2024年12月收治的择期全身麻醉下行BCP肩关节镜肩袖损伤修复术患者60例,随机分为0.9%氯化钠注射液组(NS组)与去甲肾上腺素组(NE组),各30例。NE组从麻醉诱导开始至切皮前持续泵注去甲肾上腺素(40μg/ml)1~5 ml/h,NS组以相同的速度泵注0.9%氯化钠注射液。记录麻醉诱导前(T_(1))、诱导后5 min(T_(2))、BCP时(T_(3))、BCP后5 min(T_(4))的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、心排血指数(CI)、每搏变异率(SVV)的变化情况,需额外补充血管活性药的次数、剂量。结果与T_(1)比较,NS组、NE组在T_(2)、T_(3)、T_(4)时SBP、DBP、MAP、CI明显降低,HR明显增快,SVV明显升高,差异有统计学意义(P<0.05);与T_(2)时比较,NS组SBP、DBP、MAP、CI在T_(3)、T_(4)时明显降低,HR明显增快,SVV明显升高,差异有统计学意义(P<0.05)。两组患者在同一时间点比较,T_(2)时NE组SBP、MAP、CI明显高于NS组(P<0.05),HR、SVV明显低于NS组(P<0.05);T_(3)、T_(4)时,NE组SBP、DBP、MAP、CI明显高于NS组(P<0.05),HR、SVV明显低于NS组(P<0.05)。NE组低血压发生率明显低于NS组(P<0.05),发生低血压患者需额外补充麻黄素次数和剂量明显少于NS组(P<0.05)。结论小剂量去甲肾上腺素持续泵注可有效缓解肩关节镜手术患者全身麻醉诱导期间血压下降,并减少BCP时低血压发生率,维持术中血流动力学稳定,提高手术安全性。Objective To explore the effect of low-dose norepinephrine on preventing hypotension caused by postural changes in general anesthesia in shoulder arthroscopic surgery under beach chair(BCP).Methods Sixty patients with BCP shoulder arthroscopic rotator cuff injury repair under elective general anesthesia admitted to Shunyi District Hospital from December 2023 to December 2024 were randomly divided into 0.9%sodium chloride injection group(NS group)and norepinephrine group(NE group),with 30 cases in each group.The NE group was continuously injected with norepinephrine(40μg/ml)1~5 ml/h from anesthesia induction until incision,and the NS group was injected with 0.9%sodium chloride injection at the same rate.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),heart rate(HR),cardiac output index(CI)and stroke variation rate(SVV)before anesthesia induction(T_(1)),5 min after induction(T_(2)),during BCP(T_(3))and 5 min after BCP(T_(4)),the number and dosage of additional vasoactive drugs required were recorded.Results Compared with T_(1),SBP,DBP,MAP and CI in NS group and NE group were significantly decreased at T_(2),T_(3) and T_(4),HR was significantly increased,and SVV was significantly increased,with statistical significance(P<0.05).Compared with T_(2),SBP,DBP,MAP and CI in NS group were significantly decreased at T_(3) and T_(4),HR was significantly increased,and SVV was significantly increased,with statistical significance(P<0.05).At T_(2),SBP,MAP and CI in NE group were significantly higher than those in NS group(P<0.05),while HR and SVV in NS group were significantly lower than those in NS group(P<0.05).At T_(3) and T_(4),SBP,DBP,MAP and CI in NE group were significantly higher than those in NS group(P<0.05),while HR and SVV in NS group were significantly lower than those in NS group(P<0.05).The incidence of hypotension in NE group was significantly lower than that in NS group(P<0.05),and the frequency and dose of ephedrine supplementation in patients with hypotension was signif

关 键 词：去甲肾上腺素 肩关节镜 体位 低血压 

分 类 号：R684.7[医药卫生—骨科学] R971[医药卫生—外科学]