头低脚高位20°对胃切除术患者全身麻醉诱导期低血压的影响

Effect of the 20° trendelenburg position on hypotension during induction of general anesthesia of patients undergoing gastrectomy

目的探讨头低脚高位20°对胃切除术患者全身麻醉诱导期低血压的影响。方法选择择期行根治性胃切除术患者118例,男77例,女41例,年龄50~60岁,ASAⅠ或Ⅱ级,按随机数字表法分为A组(n=40)、B组(n=38)和C组(n=40)。A组:平卧位全身麻醉诱导,出现低血压后给予心血管活性药物处理;B组:平卧位全身麻醉诱导,出现低血压后给予头低脚高位20°处理,无效者给予心血管活性药物;C组:头低脚高位20°全身麻醉诱导,出现低血压后给予心血管活性药物处理。三组均在麻醉诱导前30min内输注乳酸钠溶液15ml·kg^(-1)·h^(-1),以丙泊酚2mg/kg、舒芬太尼0.5μg/kg,罗库溴铵0.9mg/kg行麻醉诱导。记录患者麻醉诱导期低血压的发生情况和心血管活性药物的使用情况。结果 A组发生低血压19例(47.5%),B组发生14例(36.8%),C组发生6例(15.0%);A、B组低血压发生率明显高于C组(P<0.05)。A组低血压患者使用麻黄碱(7.75±6.43)mg,B组使用(5.26±2.57)mg、C组使用(5.32±2.21)mg,仅A组使用去氧肾上腺素(26.5±0.14)μg,B、C组心血管活性药物用量明显少于A组(P<0.05)。A组出现2例难治性低血压。三组患者均未发生严重的心律失常,未使用阿托品。结论头低脚高位20°可降低胃切除术患者全身麻醉诱导期的低血压发生率,且对其有治疗作用,同时可减少全身麻醉诱导期血管活性药物的使用。

Objective To explore the effect of 20°trendelenburg position on hemodynamics during induction of general anesthesia of patients under gastrectomy.Methods One hundred and eighteen patients（77males and 41 females,aged 50-60 years,ASA physical statusⅠ orⅡ）,scheduled for elective radical gastrectomy,were randomly divided into group A（n=40）,group B（n=38）and group C（n=40）.In group A,patients were placed in the supine position during induction of anesthesia,and vasopressors was administered when hypotension occurred.In group B,patients were placed in the supine position during induction of anesthesia and was placed in the 20°trendelenburg position when hypotension occurred,and vasopressor would be administered if blood pressure was not restored.In group C,patients were placed in the 20°trendelenburg position during induction of anesthesia,and vasopressors was administered when hypotension occurred.In all groups Lactated Ringer′s was infused at 15ml·kg^-1·h^-1 in 30 min before induction.Anesthesia was induced with propofol 2mg/kg,sufentanil 0.5μg/kg,rocuronium 0.9mg/kg.The occurrence of hypotension and the total amounts of drug administrations were doccumented.Results Nineteen patients（47.5%）in group A,fourteen patients（36.8%）in group B and six patients（15.0%）in group C developed hypotention.The incidence of hypotension in group A and B was significantly higher than that in group C（P〈0.05）.In all groups the total dosage of ephedrine was used[（7.75±6.43）mg vs（5.26±2.57）mg vs（5.32±2.21）mg].Phenylephine was only used in the group A at a dose of 26.5±0.14μg.The amounts of drug administrations in group B and C were significantly lower than that in group A（P〈0.05）.Two patients in group A went into a refractory hypotensive state.However,no patients in all groups fell into a serious arrhythmia state,so atropine was not used.Conclusion The 20°trendelenburg position during induction of general anesthesia of patients during gastrectomy can prevent hypotension during induction.This position is effective in the management of hypotension after the induction of general anesthesia and can decrease the amounts of drug administrations during induction of general anesthesia.