甲氧明对缩宫素致剖宫产术患者心血管反应的影响

发布时间：2018-05-28 07:11

本文选题：甲氧明 + 缩宫素　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:选择腰硬联合麻醉,观察甲氧明是否能够抵消缩宫素诱发的剖宫产术产妇心血管不良反应,以明确甲氧明的最佳处理策略及评价其在产科麻醉中缩宫素使用后的应用价值及优势。方法:⑴拟选择需要进行剖腹产的产妇120名,且怀孕为单胎的足月孕妇。ASAⅠ级或Ⅱ级。⑵所有观察对象随机分为甲氧明0.01mg/kg组(M1组)、甲氧明0.02mg/kg组(M2组)、甲氧明0.03mg/kg组(M3组)和对照组(C组),每组30名。⑶产妇入室后平卧于手术床,实时监测以下生命体征:血压(BP)、心率(HR)、心电图(ECG)和脉搏血氧饱和度(Sp O2)。麻醉前静脉输注复方氯化钠注射液8-10ml/kg。⑷协助患者改变体位为左侧卧位,选择穿刺点为L2,3间隙,注入腰麻药及置入硬膜外导管。控制感觉平面在T6-8后开始手术。⑸将10单位缩宫素在胎儿娩出后经小壶快速滴入,M1组、M2组和M3组分别经三通静注甲氧明0.01mg/kg、0.02mg/kg、0.03mg/kg(将10mg甲氧明加入生理盐水稀释至20ml,0.5mg/ml),对照组(C组)不给予任何血管收缩药。低血压指给予缩宫素后血压较给药前下降20%;高血压指给予缩宫素后血压较给药前升高20%;心动过缓指心率60次/min。当SBP较缩宫素给药前下降≥30%时,静脉注射甲氧明1-2mg;发生心动过速(HR100次/min)时,在加快输液的同时静脉注射艾司洛尔10-20mg;当心率50次/min时,给予阿托品0.3-0.5mg。若患者在给予缩宫素后发生以上情况则将其从观察对象中排除。⑹记录给予缩宫素即刻(T1)、给予后1min(T2),3min(T3),5min(T4)和10min(T5)5个时点的收缩压(SBP)、舒张压(DBP)和心率(HR);同时记录恶心、呕吐和低血压等不良反应的发生。结果:1.与C组相比,M1组、M2组、M3组组间年龄、体重、手术时间、输液量、出血量、尿量比较,差异无统计学意义(P0.05)。2.血流动力学指标比较:(1)甲氧明0.02mg/kg组(M2组)可显著缓解缩宫素所导致的收缩压降低。M1组、M2组、M3组和C组四组收缩压情况比较:组间:在T1时,四组间的收缩压差异无统计学意义(P0.05);与C组相比,M2组和M3组在T2-T4时显著增加,差异均有统计学意义(P0.05)。组内:在对照组(C组),T2、T3、T4与T1比较显著减少(P0.05);在甲氧明0.01mg/kg组(M1组),T2、T3、T4与T1比较显著减少(P0.001);在甲氧明0.02mg/kg组(M2组),T2-T5与T1相比无明显差异(P0.05),收缩压波动较小;在甲氧明0.03mg/kg组(M3组),T3、T4与T1比显著增加(P0.05)。(2)甲氧明0.02mg/kg组(M2组)可显著缓解缩宫素所导致的舒张压降低。M1组、M2组、M3组和C组四组舒张压情况比较:组间:在T1时,四组间的舒张压差异无统计学意义(P0.05);与C组相比,M2组和M3组在T2-T4时显著增加,差异均有统计学意义(P0.05)。组内:在对照组(C组),T2、T3、T4与T1比较显著减少(P0.001);在甲氧明0.01mg/kg组(M1组),T2、T3、T4与T1比较显著减少(P0.05);在甲氧明0.02mg/kg组(M2组),T2-T5与T1相比无明显差异(P0.05),舒张压波动较小。在甲氧明0.03mg/kg组(M3组),T3、T4与T1比显著增加(P0.05)。(3)甲氧明0.02mg/kg组(M2组)可显著缓解缩宫素所导致的心率增加。M1组、M2组、M3组和C组四组心率情况比较:组间:在T1时,四组间的心率差异无统计学意义(P0.05);与对照组(C组)比,甲氧明0.01mg/kg组(M1组)、甲氧明0.02mg/kg组(M2组)和甲氧明0.03mg/kg组(M3组)的心率在T2、T3时显著减少(P0.001)。组内:在对照组(C组),T2、T3与T1相比显著增加(P0.001);在甲氧明0.01mg/kg组(M1组),T3与T1相比显著增加(P0.05);在甲氧明0.02mg/kg组(M2组),T3-T5与T1相比无明显差异(P0.05);在甲氧明0.03mg/kg组(M3组),T3与T1相比显著增加(P0.05)。3.甲氧明0.02mg/kg组(M2组)发生的不良反应较少。M1组、M2组、M3组和C组四组不良反应情况比较:(1)对照组(C组)恶心的发生率显著高于M2组(p=0.044)和M3组(p=0.010),差异均有统计学意义(P0.05);对照组(C组)低血压的发生率显著高于M2组(p=0.023)和M3组(p=0.005),差异均有统计学意义(P0.05)。(2)与甲氧明0.01mg/kg组(M1组)相比,甲氧明0.02mg/kg组(M2组)不良反应发生率减少(P0.05),甲氧明0.03mg/kg组(M3组)不良反应发生率减少(P0.05)。(3)甲氧明0.02mg/kg组(M2组)和甲氧明0.03mg/kg组(M3组)不良反应发生率比较差异无统计学意义(P0.05)。(4)甲氧明0.03mg/kg组(M3组)高血压和心动过缓的发生率高于M1组、M2组和C组,差异有统计学意义(P0.05)。结论:1.采用椎管内麻醉的剖宫产患者,不同剂量的甲氧明均可以有效升高缩宫素导致的收缩压和舒张压的降低以及减低缩宫素导致的心率的增加,提示甲氧明可以有效降低患者的剖宫产术中缩宫素所引起的心血管不良反应。2.甲氧明剂量为0.01、0.02和0.03mg/kg均可降低缩宫素伴发的不良反应,且0.02mg/kg的效果优于0.01mg/kg和0.03mg/kg,提示我们在临床应用甲氧明抵抗缩宫素引起以及伴发的不良反应的适宜剂量为0.02mg/kg。
[Abstract]:Objective: to select the combined spinal and epidural anesthesia to observe whether methoxin can counteract the adverse cardiovascular response to the cesarean section induced by oxytocin to determine the best treatment strategy of methoxin and evaluate its application value and superiority after the use of oxytocin in obstetric anesthesia. Methods: (1) to choose 120 parturients who need caesarean section. .ASA I or II grade pregnant women with single fetus were randomly divided into group 0.01mg/kg (group M1), group 0.02mg/kg (group M2), methoxin group 0.03mg/kg (group M3) and control group (C group), each group was 30 in each group. (3) parturients were lying on the operating bed in the operating bed and monitored the following life signs in real time: blood pressure (BP), heart rate (HR), ECG (EC) G) and pulse oxygen saturation (Sp O2). Intravenous infusion of Compound Sodium Chloride Injection 8-10ml/kg. (4) before anesthesia to assist the patient to change the position of the left lateral position, select the puncture point as the L2,3 space, injecting the lumbar anesthetic and inserting the epidural catheter. Control the sensory plane to start the operation after T6-8. 10 units of the oxytocin will be fast after the fetus is delivered. Instillation, group M1, group M2 and M3 group were intravenously injected methoxin 0.01mg/kg, 0.02mg/kg, 0.03mg/kg (10mg methoxine diluted with saline to 20ml, 0.5mg/ml), and the control group (C group) did not give any vasoconstrictor. Hypotension indicated that the blood pressure after administration of oxytocin was 20% lower than that before administration; hypertension refers to the blood pressure of oxytocin before the medicine was given up. High 20%; bradycardia heart rate 60 /min. when SBP than oxytocin before the drop of 30%, intravenous methoxin 1-2mg; tachycardia (HR100 times /min), at the same time to accelerate infusion at the same time intravenous injection of esmolol 10-20mg; heart rate when the rate of /min, give atropine 0.3-0.5mg. if patients after giving the uterine contraction after the above situation is the case The records were removed from the observed subjects. The records were recorded for T1, systolic pressure (SBP), diastolic pressure (DBP) and heart rate (HR) at the 5 time points of 1min (T2), 3min (T3), 5min (T4) and 10min (T5); and the occurrence of nausea, vomiting and hypotension at the same time. Results: 1. Time, infusion volume, bleeding volume, urine volume, the difference was not statistically significant (P0.05).2. hemodynamic indexes: (1) methoxin 0.02mg/kg group (M2 group) can significantly alleviate the contraction pressure induced by oxytocin group.M1, M2 group, M3 group and C group four groups systolic pressure situation: between groups: at T1, there is no statistical difference between the four groups of systolic pressure. P0.05); compared with group C, group M2 and M3 were significantly increased at T2-T4, and the difference was statistically significant (P0.05). In the control group (group C), T2, T3, T4 and T1 were significantly reduced (P0.05); In the group of methoxin 0.03mg/kg (group M3), T3, T4 and T1 increased significantly (P0.05). (2) methoxin 0.02mg/kg group (M2 group) could significantly alleviate the diastolic pressure caused by oxytocin in group.M1, the diastolic pressure in the four groups of M2, M3 and C groups: between the four groups there was no statistical difference between the four groups; Group M2 and M3 were significantly increased at T2-T4, and the difference was statistically significant (P0.05). In the control group (C group), T2, T3, T4 and T1 were significantly reduced (P0.001), and in the 0.01mg/kg group of methoxim (M1 group) In the group of methoxin 0.03mg/kg (group M3), T3, T4 and T1 were significantly increased (P0.05). (3) methoxin 0.02mg/kg group (M2 group) can significantly alleviate the heart rate caused by oxytocin group.M1 group, M2, M3 group and C group four groups heart rate comparison: between the four groups, there is no statistical difference between the four groups of heart rate difference; and a control group (Group), a ratio, a The heart rate of group 0.01mg/kg (group M1), methoxin 0.02mg/kg group (group M2) and methoxin 0.03mg/kg group (M3 group) decreased significantly at T2, T3 (P0.001). In the control group (C group), T2, T3 was significantly increased; Compared with no significant difference (P0.05), in the group of methoxin 0.03mg/kg (group M3), T3 and T1 significantly increased (P0.05).3. methoxin 0.02mg/kg group (M2 group) with less adverse reactions in the group of.M1, M2 group, M3 group and four groups of adverse reactions: (1) the incidence of nausea in the control group was significantly higher than that of the group. The incidence of hypotension in the control group (group C) was significantly higher than that in group M2 (p=0.023) and M3 group (p=0.005), and the difference was statistically significant (P0.05). (2) the incidence of adverse reactions in methoxin 0.02mg/kg group (M2 group) decreased (P0.05), and the incidence of adverse reactions in methoxin group decreased (2). 5). (3) there was no significant difference in the incidence of adverse reactions between methoxin group 0.02mg/kg (group M2) and methoxin group 0.03mg/kg (group M3). (4) the incidence of hypertension and bradycardia in group 0.03mg/kg (group M3) was higher than that of M1 group, M2 group and C group (P0.05). Conclusion: 1. with intraspinal anesthesia in caesarean section, Different doses of methoxin can effectively increase the decrease of systolic and diastolic pressure induced by oxytocin and reduce the increase of heart rate induced by oxytocin, suggesting that methoxin can effectively reduce the cardiovascular adverse reaction caused by oxytocin in caesarean section of patients with.2. methoxy dose of 0.01,0.02 and 0.03mg/kg can reduce the uterine contraction. The effect of 0.02mg/kg is better than that of 0.01mg/kg and 0.03mg/kg, suggesting that the suitable dose of methoxin to resist the oxytocin and the adverse reactions associated with the concomitant hair is 0.02mg/kg..
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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