预注甲氧明联合阿托品对腰麻下行前列腺电切术老年患者血流动力学的影响

The hemodynamics effects of methoxamine in combination with atropine on elderly patients undergoing TURP under spinal anesthesia

目的观察预注甲氧明联合阿托品对腰麻下行前列腺电切手术老年患者血流动力学的影响。方法选择ASAⅠ～Ⅱ级择期行前列腺电切手术患者90例,随机分成3组,每组30例,A组作为对照组常规腰麻,其余两组分别在腰麻后静脉缓慢推注甲氧明2 mg(B组)和甲氧明2 mg+阿托品0.3 mg(C组)。三组中当收缩压下降超过基础值的20%时每次追加麻黄素3 mg。记录入室基础值和腰麻后2 min、5 min、10 min各组患者收缩压、舒张压、心率的值及麻黄素追加的例数。结果与基础值比较,A组收缩压,舒张压和心率有明显变化(P<0.05),麻黄素的追加次数明显超过B组和C组(P<0.05);B组收缩压、舒张压无明显统计学差异(P>0.05),心率有明显变化(P<0.05);C组收缩压、舒张压及心率均无明显统计学差异(P>0.05)。结论甲氧明能有效地防止低血压的发生,阿托品能够预防心率减慢,甲氧明与阿托品联合应用使老年患者在腰麻下行前列腺电切手术血流动力学更加稳定。

Objective To investigate the hemodynamic effects of combined application of methoxamine and atropine on elderly patients undergoing transurethral resection of the prostate （TURP） under spinal anesthesia. Methods Ninety patients, ASAI - II, were randomly distributed to Group A（n =30）, Group B（n =30）, and Group C（n =30）. Group A was control and chose spinal anesthesia; in Group B 2rag methoxamine was intravenously injected after spinal anesthesia; in Group C 2rag methoxamine plus 0.3rag atropine was intravenously injected after spinal anesthesia. When the systolic pressure decreased more than 20% compared with basal blood pressure in the 3 groups, 3rag ephedrine was intravenously injected. The heart rate, both systolic and diastolic pressure were recorded at entering into operating room and 2min,5min, 10min after spinal anesthesia in 3 groups. The number of cases used ephedrine was recorded. Results Compared with basal blood pressure, the heart rate and both systolic and diastolic pressure had significant difference （ P 〈 0.05 ） in Group A ; both systolic and diastolic pressure had no significant difference （ P 〉 0.05 ）, but the heart rate had significant difference （ P 0.05 ） in Group B ; the heart rate and both systolic and diastolic pressure had no significant difference （ 〉 0.05 ） in Group C. Conclusion Combined application of methoxamine and atropine is helpful for hemodynamics stabilization in elderly patients undergoing TURP under spinal anesthesia.