异丙酚无痛人工流产时静脉注射缩宫素可致血液循环严重波动

Critical hemodynamic changes caused by injection of oxytocin during termination of pregnancy with propofol

目的 观察异丙酚无痛人工流产时静脉注射缩宫素对血压和心率的影响。 方法 将 90例Ⅰ级 (美国麻醉协会麻醉术前分级 )早期宫内妊娠的患者随机分为 3组 :A组 30例 ,应用 2～ 3mg/kg异丙酚和 1μg/kg枸橼酸芬太尼进行无痛人工流产术 ,手术后期注射缩宫素 1ml,于注射后的 3min内观察收缩压、舒张压和心率变化 ;B组 30例 ,用相同麻醉方法进行无痛人工流产 ,术中不用缩宫素 ,观察指标与方法同于A组 ;C组 30例 ,不用任何麻醉药物进行人工流产 ,在与A组相同的时间注射缩宫素 ,观察指标与方法同于A组。 结果 A组在注射缩宫素后 0 5min ,血压显著下降 ,心率显著增加 ,注射后 2 .5min时 ,血压和心率基本恢复到注射前水平。B组和C组无明显血压下降。 结论 异丙酚无痛人工流产时注射常规剂量缩宫素后可致血液循环短暂严重波动 ,应引起临床妇产科医师高度重视 ,特别是对心功能储备较差的患者更应关注。

Objective To observe the influence of oxytocin on blood pressure and heart rate during termination of pregnancy with propofol anesthesia. Methods 90 patients, undergoing termination of pregnancy, were randomly allocated into three groups. Patients in groups A and B (30 in each group)were anesthetized with 2～3 mg/kg propofol and 1 μg/kg fentanyl, while only patients in group A received 10 u oxytocin intravenously at the later stage of operative procedure. Patients in group C ( n =30) were performed without anesthesia and 10 u oxytocin was administered at the same time point as group A. Systolic pressure, diastolic pressure and heart rate were measured at 0.5 minute intervals for 3 min after injection of oxytocin or saline. Results Critical hemodynamic fluctuation was observed within 3 min after injection of oxytocin which was typically represented by a significant falling of systolic pressure and diastolic pressure and a significant increase of heart rate. The changes of hemodynamics were returned to the baseline within 3 min without any treatment. Conclusion Intravenous injection of oxytocin during termination of pregnancy with propofol anesthesia can result in a transient and critical hemodynamic fluctuation. More attentions should be paid to the patients with limited cardiac reserve.