本文選題：甲氧明 + 縮宮素��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:選擇腰硬聯(lián)合麻醉,觀察甲氧明是否能夠抵消縮宮素誘發(fā)的剖宮產(chǎn)術(shù)產(chǎn)婦心血管不良反應(yīng),以明確甲氧明的最佳處理策略及評價其在產(chǎn)科麻醉中縮宮素使用后的應(yīng)用價值及優(yōu)勢。方法:⑴擬選擇需要進行剖腹產(chǎn)的產(chǎn)婦120名,且懷孕為單胎的足月孕婦。ASAⅠ級或Ⅱ級。⑵所有觀察對象隨機分為甲氧明0.01mg/kg組(M1組)、甲氧明0.02mg/kg組(M2組)、甲氧明0.03mg/kg組(M3組)和對照組(C組),每組30名。⑶產(chǎn)婦入室后平臥于手術(shù)床,實時監(jiān)測以下生命體征:血壓(BP)、心率(HR)、心電圖(ECG)和脈搏血氧飽和度(Sp O2)。麻醉前靜脈輸注復(fù)方氯化鈉注射液8-10ml/kg。⑷協(xié)助患者改變體位為左側(cè)臥位,選擇穿刺點為L2,3間隙,注入腰麻藥及置入硬膜外導(dǎo)管�？刂聘杏X平面在T6-8后開始手術(shù)。⑸將10單位縮宮素在胎兒娩出后經(jīng)小壺快速滴入,M1組、M2組和M3組分別經(jīng)三通靜注甲氧明0.01mg/kg、0.02mg/kg、0.03mg/kg(將10mg甲氧明加入生理鹽水稀釋至20ml,0.5mg/ml),對照組(C組)不給予任何血管收縮藥。低血壓指給予縮宮素后血壓較給藥前下降20%;高血壓指給予縮宮素后血壓較給藥前升高20%;心動過緩指心率60次/min。當(dāng)SBP較縮宮素給藥前下降≥30%時,靜脈注射甲氧明1-2mg;發(fā)生心動過速(HR100次/min)時,在加快輸液的同時靜脈注射艾司洛爾10-20mg;當(dāng)心率50次/min時,給予阿托品0.3-0.5mg。若患者在給予縮宮素后發(fā)生以上情況則將其從觀察對象中排除。⑹記錄給予縮宮素即刻(T1)、給予后1min(T2),3min(T3),5min(T4)和10min(T5)5個時點的收縮壓(SBP)、舒張壓(DBP)和心率(HR);同時記錄惡心、嘔吐和低血壓等不良反應(yīng)的發(fā)生。結(jié)果:1.與C組相比,M1組、M2組、M3組組間年齡、體重、手術(shù)時間、輸液量、出血量、尿量比較,差異無統(tǒng)計學(xué)意義(P0.05)。2.血流動力學(xué)指標(biāo)比較:(1)甲氧明0.02mg/kg組(M2組)可顯著緩解縮宮素所導(dǎo)致的收縮壓降低。M1組、M2組、M3組和C組四組收縮壓情況比較:組間:在T1時,四組間的收縮壓差異無統(tǒng)計學(xué)意義(P0.05);與C組相比,M2組和M3組在T2-T4時顯著增加,差異均有統(tǒng)計學(xué)意義(P0.05)。組內(nèi):在對照組(C組),T2、T3、T4與T1比較顯著減少(P0.05);在甲氧明0.01mg/kg組(M1組),T2、T3、T4與T1比較顯著減少(P0.001);在甲氧明0.02mg/kg組(M2組),T2-T5與T1相比無明顯差異(P0.05),收縮壓波動較小;在甲氧明0.03mg/kg組(M3組),T3、T4與T1比顯著增加(P0.05)。(2)甲氧明0.02mg/kg組(M2組)可顯著緩解縮宮素所導(dǎo)致的舒張壓降低。M1組、M2組、M3組和C組四組舒張壓情況比較:組間:在T1時,四組間的舒張壓差異無統(tǒng)計學(xué)意義(P0.05);與C組相比,M2組和M3組在T2-T4時顯著增加,差異均有統(tǒng)計學(xué)意義(P0.05)。組內(nèi):在對照組(C組),T2、T3、T4與T1比較顯著減少(P0.001);在甲氧明0.01mg/kg組(M1組),T2、T3、T4與T1比較顯著減少(P0.05);在甲氧明0.02mg/kg組(M2組),T2-T5與T1相比無明顯差異(P0.05),舒張壓波動較小。在甲氧明0.03mg/kg組(M3組),T3、T4與T1比顯著增加(P0.05)。(3)甲氧明0.02mg/kg組(M2組)可顯著緩解縮宮素所導(dǎo)致的心率增加。M1組、M2組、M3組和C組四組心率情況比較:組間:在T1時,四組間的心率差異無統(tǒng)計學(xué)意義(P0.05);與對照組(C組)比,甲氧明0.01mg/kg組(M1組)、甲氧明0.02mg/kg組(M2組)和甲氧明0.03mg/kg組(M3組)的心率在T2、T3時顯著減少(P0.001)。組內(nèi):在對照組(C組),T2、T3與T1相比顯著增加(P0.001);在甲氧明0.01mg/kg組(M1組),T3與T1相比顯著增加(P0.05);在甲氧明0.02mg/kg組(M2組),T3-T5與T1相比無明顯差異(P0.05);在甲氧明0.03mg/kg組(M3組),T3與T1相比顯著增加(P0.05)。3.甲氧明0.02mg/kg組(M2組)發(fā)生的不良反應(yīng)較少。M1組、M2組、M3組和C組四組不良反應(yīng)情況比較:(1)對照組(C組)惡心的發(fā)生率顯著高于M2組(p=0.044)和M3組(p=0.010),差異均有統(tǒng)計學(xué)意義(P0.05);對照組(C組)低血壓的發(fā)生率顯著高于M2組(p=0.023)和M3組(p=0.005),差異均有統(tǒng)計學(xué)意義(P0.05)。(2)與甲氧明0.01mg/kg組(M1組)相比,甲氧明0.02mg/kg組(M2組)不良反應(yīng)發(fā)生率減少(P0.05),甲氧明0.03mg/kg組(M3組)不良反應(yīng)發(fā)生率減少(P0.05)。(3)甲氧明0.02mg/kg組(M2組)和甲氧明0.03mg/kg組(M3組)不良反應(yīng)發(fā)生率比較差異無統(tǒng)計學(xué)意義(P0.05)。(4)甲氧明0.03mg/kg組(M3組)高血壓和心動過緩的發(fā)生率高于M1組、M2組和C組,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1.采用椎管內(nèi)麻醉的剖宮產(chǎn)患者,不同劑量的甲氧明均可以有效升高縮宮素導(dǎo)致的收縮壓和舒張壓的降低以及減低縮宮素導(dǎo)致的心率的增加,提示甲氧明可以有效降低患者的剖宮產(chǎn)術(shù)中縮宮素所引起的心血管不良反應(yīng)。2.甲氧明劑量為0.01、0.02和0.03mg/kg均可降低縮宮素伴發(fā)的不良反應(yīng),且0.02mg/kg的效果優(yōu)于0.01mg/kg和0.03mg/kg,提示我們在臨床應(yīng)用甲氧明抵抗縮宮素引起以及伴發(fā)的不良反應(yīng)的適宜劑量為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..
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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