上胸段、胸腰段硬膜外麻醉对阿托品增加心率作用的影响

A STUDY OF THE EFFECT OF ATROPINE ON INCREASING HEART RATE FOLLOWING EPIDURAL ANESTHESIA BY WAY OF THE UPPER THORACIC AND THORACOLUMBAR SEGMENT ROUTES

目的：比较不同节段硬膜外麻醉对阿托品增加心率作用的影响。方法：１８例ＡＳＡＩ级成年女性患者分成三组，上胸组经Ｔ（２－３）脊椎间隙硬外穿剌，胸腰组经Ｔ（１２）Ｌ（１）脊椎间隙穿剌，两组均置入导管４ｃｍ，颈丛、臂丛阻滞麻醉为对照组。上胸组给予１．５％利多卡因６ｍｌ～８ｍｌ，胸腰组给予１２ｍｌ。麻醉后测血压、心率，１５分钟后测麻醉最大平面及血压、心率，静注阿托品０．０１ｍｇ／Ｋｇ，连续测血压、心率。对照组方法相同但不经硬膜外给药。结果：对照组静注阿托品后心率增加最大，胸腰组其次，上胸组明显少于另两组（Ｐ＜０．０５）。结论：不同节段硬膜外麻醉对阿托品增加心率作用的影响不同。

objective:To evaluate the effect of atropine on increasing the heart rate following epidual anesthesia by way of the upper thoracic and thoracolumbar segment routesMethods:The 28 ASA grade-1 cases of adult female were divided into 3 groups:for upper thoracic group the interverbebral epidural punctures were made at T2～3 and that for thoracolumber group being at T2～L1 and a 4cm tubing was fixed in situ for both groups,and for the control group being cervical,arm plexas anesthesiaIn doing so 6ml～8ml of 15% lidocaine was given for the lst group and 12ml for the 2nd groupBoth before and after the blocking ,patients′BP、HR were measured and 15 min after the blocking patients analgesic level BP and HR were measured and 0.01mg/Kg of atropine was administered intravenously,5min later patients′BP、HR were measuredResults:The increase of HR by aropine was the highest for the control group,next for the thoracolumbar group and that for the upper thoracic group was less than the other two groups(P<0.05)Conclusion:There are different degrees of HR increase by atropine for epidural anesthesia given at diffenent segments and for the poor increase of HR by atropine to upper thoracic anesthesia the dose of tropine should be properly increased 