麻黄碱与去氧肾上腺素对全麻俯卧位手术患者血流动力学影响的比较

Comparison of effects of ephedrine and phenylephrine on hemodynamics in patients undergoing surgery in prone position under general anesthesia

目的 比较麻黄碱与去氧肾上腺素对全麻俯卧位手术患者血流动力学的影响.方法 择期全麻俯卧位下行后路腰椎融合术患者60例,性别不限,年龄20 ～ 60岁,体重指数18.5～25.0 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组（n=30）：麻黄碱组（E组）和去氧肾上腺素组（P组）.俯卧位期间发生低血压（收缩压降低幅度＞基础值20％,T0）时记录SBP、DBP、MAP、HR、CO、CI和CVP,并经中心静脉注射麻黄碱0.1 mg/kg（E组）或去氧肾上腺素1μg/kg（P组）,注药后10 min内每分钟（T1-T10）记录上述指标.结果 麻黄碱及去氧肾上腺素均可维持患者血流动力学指标在正常水平.与T0时比较,E组T1-T10时SBP、DBP、MAP和HR、T2-T10时CO和CI升高（P＜0.05）,给药后各时点CVP差异无统计学意义（P＞0.05）,P组T1-T6时SBP和MAP、T1-T5时DBP、T2和T3时CVP、T1-T3时CO和CI升高,T1和T2时HR降低（P＜0.05）.与P组比较,E组SBP T1时降低,T2-T10时升高;DBP和MAP T1时降低,T3-T10时升高;HR T1-T10时升高;CO及CI T2-T10时升高;CVP T1-T3时降低（P＜0.05）.结论 与去氧肾上腺素相比,虽然麻黄碱对全麻俯卧位手术患者升血流动力学的影响无明显临床意义,但可在一定程度上增加心输出量.

Objective To compare the effects of ephedrine and phenylephrine on hemodynamics in the patients undergoing surgery in prone position under general anesthesia.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 20-60 yr, with body mass index of 18.5-2：5.0 kg/m2, scheduled for elective posterior lumbar interbody fusion under general anesthesia, were randomized to ephedrine group （group E, n =30） or phenylephrine group （group P, n =30）.When hypotension [decrease in systolic blood pressure （SBP） 〉20% of the baseline value, T0] occurred in supine position, SBP, diastolic blood pressure （DBP）, mean arterial pressure （MAP）, heart rate （HR）, cardiac output （CO）, cardiac index （CI） and central venous pressure （CVP） were recorded, and ephedrine 0.1 mg/kg （group E） or phenylephrine 1 μg/kg （group P） was injected via the central veins.The parameters mentioned above were recorded within 10 min after administration （T1-T10）.Results Both ephedrine and phenylephrine could maintain the parameters of hemodynamics at the normal level.Compared with the baseline values at T0 , SBP, DBP, MAP and HR at T1-T10 and CO and CI at T2-T10 were significantly increased, and no significant change was found in CVP at each time point after administration in group E, and SBP and MAP at T1-T6, DBP at T1-T5, CVP at T2 and T3, and CO and CI at T1-T3 were significantly increased, and HR was decreased at T2 and T3 in group P.Compared with group P, SBP was significantly decreased at T1, and increased at T2-T10, DBP and MAP were decreased at T1, and increased at T3-T10, HR was increased at T1-T10, CO and CI were increased at T2-T10, and CVP was decreased at T1-T3 in group E.Conclusion Compared with phenylephrine, although ephedrine provides no significant effect on hemodynamics clinically, it can increase cardiac output to some extent in the patients undergoing surgery in prone position under general anesthesia.