Soliman Rabie, Yacoub Abdelbadee, Elbiaa Assem A M
Aldar Hospital, Almadinah Almonwarah, Saudi Arabia.
Department of Anaesthesia, Faculty of Medicine, Al Azhar University, Egypt.
Indian J Anaesth. 2021 Feb;65(2):139-145. doi: 10.4103/ija.IJA_363_20. Epub 2021 Feb 10.
Myomectomy is associated with perioperative bleeding. The aim of the study is to evaluate the effect of intramyometrial vasopressin on blood loss and the associated cardiovascular complications during myomectomy.
The study included 194 patients classified into two groups- 1) Vasopressin group: the vasopressin was diluted as 0.1 unit/ml and 15 ml was injected by the surgeon in the plane between the myometrium and the myoma. 2) Control group: The patients received an equal amount of normal saline. The monitored parameters included the amount of blood loss, required blood transfusion, heart rate, mean arterial blood pressure, the incidence of hypertension, hypotension, bradycardia, tachycardia, electrocardiogram (ECG) changes and the blood troponin I level.
The heart rate decreased significantly in both groups, but the decrease was lower with vasopressin than the control group through the time points T3 to T5 ( < 0.05) The mean arterial blood pressure increased significantly in both groups, but the increase was higher with vasopressin than the control group through T3 to T5 ( < 0.05). The amount of blood loss decreased significantly with vasopressin than the control groups ( = 0.001). The number of transfused packed red blood cells was lower with vasopressin than the control group ( = 0.001). The incidence of hypertension, bradycardia and atrial extrasystole was higher with vasopressin than the control group ( = 0.005, = 0.012, = 0.033, respectively).
Intramyometrial vasopressin decreases blood loss and blood transfusion, but it is associated with cardiovascular complications that may be serious as reported in other studies. Therefore, anaesthesiologists and gynaecologists must follow the precautions to avoid and minimise the incidence of complications with intramyometrial vasopressin.
子宫肌瘤剔除术与围手术期出血相关。本研究的目的是评估子宫肌层内注射血管加压素对子宫肌瘤剔除术期间失血及相关心血管并发症的影响。
该研究纳入了194例患者，分为两组：1）血管加压素组：血管加压素稀释为0.1单位/毫升，由外科医生在子宫肌层和肌瘤之间的平面注射15毫升。2）对照组：患者接受等量的生理盐水。监测参数包括失血量、所需输血量、心率、平均动脉血压、高血压、低血压、心动过缓、心动过速的发生率、心电图（ECG）变化以及血肌钙蛋白I水平。
两组心率均显著下降，但在时间点T3至T5期间，血管加压素组心率下降幅度低于对照组（<0.05）。两组平均动脉血压均显著升高，但在T3至T5期间，血管加压素组升高幅度高于对照组（<0.05）。与对照组相比，血管加压素组失血量显著减少（=0.001）。血管加压素组输注的红细胞压积数量低于对照组（=0.001）。血管加压素组高血压、心动过缓和房性早搏的发生率高于对照组（分别为=0.005、=0.012、=0.033）。
子宫肌层内注射血管加压素可减少失血和输血，但正如其他研究所报道的，它与可能严重的心血管并发症相关。因此，麻醉医生和妇科医生必须遵循预防措施，以避免和减少子宫肌层内注射血管加压素并发症的发生率。
