麻黄碱对蛛网膜下腔阻滞低血压的预防作用

Preventive Effect of Ephedrine on the Hypotension Spinal Anesthesia

目的：观察预防性注射麻黄碱对成年或老年病人腰麻期间血压的影响。方法：６０例ＡＳＡⅠ～ Ⅱ级择期手术病人根据年龄和是否预防性注射麻黄碱而分成四组，Ⅰ、Ⅱ组为２５～５５岁成年病人，Ⅲ、Ⅳ组为６５～７５岁老年病人。腰麻前３０分钟快速静脉输注乳酸林格氏液７ｍｌ／ｋｇ。腰麻完成后，Ⅱ组、Ⅳ组静注麻黄碱１０ｍｇ的同时肌注３０ｍｇ；Ⅰ组、Ⅲ组则给予等容量的生理盐水。结果：３０例未用麻黄碱者，麻醉后每例ＭＡＰ降均大于２０％，其中１０例（Ⅰ组２例，Ⅲ组８例）血压下降超过３５％而需紧急处理。Ⅲ组５３％病人血压下降超过３５％。结论：预防性注射麻黄碱能有效地防治腰麻所致的低血压，对老年病人效果更佳。

Objective: To evaluate the preventive effect of ephedrine on hypotension under spinal anesthesia in patients with different age. Methods: Sixty patients scheduled for spinal anesthesia were randomly allocated to four groups with 15 each. Group Ⅰ and Ⅱ were adult patients aged from 25 to 55 years old and group Ⅲ and Ⅳ were geratic aged patients of 6575 years old. Every patient received a fluid loading of 7ml/kg before spinal anesthesia. The ephedrine was administrated to group Ⅱ and Ⅳ patients in a dose of 10mg i v and 30 mg i m and same amount of normal saline was administrated to group Ⅰ and Ⅲ as soon as spinal anesthesia was performed. Results:Thirty patients in the placebo groups developed a maximal decrease in MAP exceeding 20%. Ten of these (2 in group Ⅰ and 8 in group Ⅲ) developed a decrease in MAP exceeding 35% and required treatment. In aged groups, all patients in group Ⅲ had a decrease in MAP exceeding 20%, 53% of whom, the decrease exceeded 35%. Conclusion: Prophylactic use of ephedrine is effective in the prevention of bypotension during spinal anesthesia, especially in aged patients.