Department of Anesthesia, Lankenau Hospital and Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA.
J Clin Anesth. 2011 Aug;23(5):361-6. doi: 10.1016/j.jclinane.2010.12.008. Epub 2011 May 31.
To determine if prophylactic glycopyrrolate prevents bradycardia after spinal anesthesia.
Prospective, randomized, double-blinded, placebo-controlled study.
Large university-affiliated community hospital.
81 consecutive term parturients (not in active labor) who were scheduled for elective Cesarean section.
Parturients received 1.0 to 1.5 L of intravenous Ringer's lactate and either glycopyrrolate 0.4 mg or an equal volume of saline, with caregivers blinded to the immediate sequelae of study drug. Each patient received intrathecal bupivacaine (12 to 14 mg) with morphine sulfate (0.1 to 0.2 mg).
Continuous heart rate (HR) and blood pressure monitoring occurred for 20 minutes, with the minimum HR recorded for each 5-minute epoch. Heart rates < 60 beats per minute defined bradycardia. Heart rate variability (HRV) analysis occurred offline.
None of 34 patients administered glycopyrrolate and 6 of 35 (17%) patients receiving saline experienced bradycardia (P = 0.02476). Time domain, frequency domain, and nonlinear and embedded spectrum entropy analyses all reflected the decrease in HRV accompanying administration of glycopyrrolate.
Bradycardia after spinal anesthesia occurs commonly. Prophylactic glycopyrrolate may prevent the bradycardia, but not necessarily the hypotension.
确定预防性给予格隆溴铵是否可预防椎管内麻醉后的心动过缓。
前瞻性、随机、双盲、安慰剂对照研究。
大型大学附属社区医院。
81 例连续的足月产妇（未处于活跃分娩期），择期行剖宫产术。
产妇接受 1.0 至 1.5 L 的静脉林格氏乳酸盐，以及格隆溴铵 0.4 mg 或等量生理盐水，护理人员对研究药物的即时后果不知情。每位患者接受鞘内布比卡因（12 至 14 mg）和硫酸吗啡（0.1 至 0.2 mg）。
连续监测心率（HR）和血压 20 分钟，记录每个 5 分钟时相的最低 HR。心率 < 60 次/分钟定义为心动过缓。离线进行心率变异性（HRV）分析。
接受格隆溴铵的 34 例患者中无一例发生心动过缓，而接受生理盐水的 35 例患者中有 6 例（17%）发生心动过缓（P = 0.02476）。时域、频域和非线性及嵌入式频谱熵分析均反映了格隆溴铵给药后 HRV 的下降。
椎管内麻醉后心动过缓很常见。预防性给予格隆溴铵可能预防心动过缓，但不一定预防低血压。
