CAJ | 학술논문

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.
목적 비교마황감여거양신상선소대전마부와위수술환자혈류동역학적영향.방법 택기전마부와위하행후로요추융합술환자60례,성별불한,년령20 ～ 60세,체중지수18.5～25.0 kg/m2,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법분위2조(n=30):마황감조(E조)화거양신상선소조(P조).부와위기간발생저혈압(수축압강저폭도＞기출치20％,T0)시기록SBP、DBP、MAP、HR、CO、CI화CVP,병경중심정맥주사마황감0.1 mg/kg(E조)혹거양신상선소1μg/kg(P조),주약후10 min내매분종(T1-T10)기록상술지표.결과 마황감급거양신상선소균가유지환자혈류동역학지표재정상수평.여T0시비교,E조T1-T10시SBP、DBP、MAP화HR、T2-T10시CO화CI승고(P＜0.05),급약후각시점CVP차이무통계학의의(P＞0.05),P조T1-T6시SBP화MAP、T1-T5시DBP、T2화T3시CVP、T1-T3시CO화CI승고,T1화T2시HR강저(P＜0.05).여P조비교,E조SBP T1시강저,T2-T10시승고;DBP화MAP T1시강저,T3-T10시승고;HR T1-T10시승고;CO급CI T2-T10시승고;CVP T1-T3시강저(P＜0.05).결론 여거양신상선소상비,수연마황감대전마부와위수술환자승혈류동역학적영향무명현림상의의,단가재일정정도상증가심수출량.
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.