摘要
目的 观察在连续腰麻下牵拉子宫对血液动力学及血浆TXA2、PGI2水平的影响。方法 子宫切除术病人30例,选L2-3间隙行蛛网膜下腔穿刺,置入 Spinocath导管,通过留置的导管注入的重比重0.5％布比卡因进行连续腰麻,观察子宫牵拉前后血液动力学的变化,并于麻醉前、手术前、牵拉子宫前、牵拉子宫10min及手术后15min抽静脉血测定血浆TXB2、6-keto-PGF1α的浓度。结果连续腰麻下,镇痛肌松效果均满意,下肢运动均达完全阻滞。在子宫切除术中牵拉于宫后血压下降明显,心率减慢（P<0.05）;子宫牵拉10min时血浆TXB2、6-keto-PGF1α的水平明显增高（P<0.01）,TXB2/6-keto-PGF1α（T/K）比值显著降低（P<0.01）;子宫牵拉所致的低血压与6-keto-PGF1α、T/K比值的变化有相关性（P<0.05）。结论 在连续腰麻下,牵拉子宫可造成血液动力学的改变,与牵拉子宫引起PGI2的释放,T/K的比值降低有关。
Objective To determine the changes in hemodynamics and plasma PGI2, TXA2 levels caused by uterus traction during operation under continuous spinal anesthesia. Methods Thirty ASA Ⅰ -Ⅱpatients undergoing hysterectomy under continuous spinal anesthesia (CSA) were studied. Aged ranged from 28 to 65 years, height from 150-171 cm and body weight 40-72kg. The patients were premedicated with intramuscular phenobarbital sodium 0.1g and atropine 0.5mg 30 min before surgery. Continuous spinal anesthesia (CSA) was performed at L2-3 with 22G Spinocath ( Braun) . Hyperbaric bupivacaine 0.5% (0.75 % bupivacaine 4ml+ 10 % glucose 2ml) was injected and the height of block was maintained at T8 . Venous blood samples were taken before anesthesia (T0 ), before skin incision ( T1 ), before traction on uterus (T2 ), uterus was being pulled for 10min (T3 ) and 15 min after the end of surgery (T4 ) for determination of 6-keto-PGF1** and TXB2 . BP, HR, SpO2 and ECG were continuously monitored during surgery. Results Continuous spinal anesthesia provided perfect analgesia and satisfactory muscle relaxation. MAP and HR decreased significantly when uterus was pulled (P<0.05). The plasma 6-keto-PGFlα and TXB2 levels significantly increased at T3 and TXB2/6-keto-PGF1α ratio decreased significantly. There was a close relationship, between hypotension and plasma 6-keto-PGFIα level and TXB2/6-keto-PGFlα ratio during uterus traction. Conclusion The hemodynamic changes during uterus traction may be closely related to the PGI2 release and decrease in TXB2/6-keto-PGFlα ratio.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2002年第8期468-470,共3页
Chinese Journal of Anesthesiology
