鞘内新斯的明对布比卡因腰麻后低血压的预防作用

The prophylactical effect of intrathecal neostigmine on hypotension induced by bupivacaine-spinal-anesthesia.

目的 临床观察不同剂量新斯的明鞘内注入对布比卡因腰麻后血压及心率的影响。方法 选择ASA 1～ 2级的病人 131例 ,随机分为对照组、实验 1组、实验 2组、实验 3组。对照组采用布比卡因 ,实验组采用布比卡因加不同剂量的新斯的明。观察注药后血压及心率的变化 ,以及恶心、呕吐发生率等。结果 麻醉后 ,对照组血压明显降低 ,实验各组则明显升高 ,血压升高与新斯的明用量无明显关系。各组心率的增加相似。恶心、呕吐发生率与新斯的明剂量有关。

Objective Hypotension is an important side effect of spinal anesthesia.Intrathecal cholinergic agonists,including neostigmine,increase arterial blood pressure by stimulating spinal sympathetic neurons as reported in various animal studies.Therefore,we tested and observed clinically the prophylactical effect of intrathecal neostigmine on hypotension induced by bupivacaine-spinal-anesthesia.Methods 131 adult ASAⅠ～Ⅱ patients scheduled for elective operation under spinal anesthesia were enrolled in this study,and randomly divided into four groups:control group;test group l;test group 2;test group 3.All patients were premedicated with intramuscular 0.5mg atropine and 0.1g sodium luminal.All patients were anesthetized by spinal block with 0.5%bupivacaine 3ml(isobaric)at L2～4.Neostigmine 0.15mg,0.1mg,0.05mg were added into bupivacaine respectively in test group1,2 and 3.Arterial blood pressure and heart rate were observed and recorded before anesthesia and 5,10,15,20,25,30min after spinal block.Ringer's solution was infused at rate of 4～5ml/min and no auxillary drugs were administered during observation.Results Both systolic and diastolic arterial pressures increased after anesthesia in all the three test groups for more than 30 minute,but decreased in control group.However,no clear relationship was found between doses tested and vasopressor effect of intrathecal neostigmine.HR increased in all groups.Incidences of nausea and vomiting,as main complications,were lowered with decreasing dosage of neostigmine.Conclusion Vasopressor effect of intrathecal neostigmine which lasts more than half an hour,lessens hypotension induced by spinal anesthesia.However,the most proper dosage of neostigmine should be found in order to avoid other side-effects.