脊髓麻醉及使用甲氧明进行血管加压素治疗期间手臂和腿部的血流及血管阻力变化

Changes in blood flow and vascular resistance in the arm and leg during spinal anaesthesia and vasopressor therapy with methoxamine.

作者信息

Fogarty D J, Howe J P

机构信息

Department of Anaesthetics, Queen's University of Belfast.

出版信息

Anaesthesia. 1993 May;48(5):387-9. doi: 10.1111/j.1365-2044.1993.tb07009.x.

DOI:10.1111/j.1365-2044.1993.tb07009.x

PMID:8317645

Abstract

The effects of subarachnoid block with hyperbaric bupivacaine 0.5% on forearm and calf blood flow and vascular resistance were examined using venous occlusion plethysmography in 10 fit patients. Following blockade there was an increase in mean (SD) calf blood flow from 2.0 (0.4) to 2.6 (1.2) ml.100 ml-1.min-1 (p = 0.057), a decrease in mean (SD) calf vascular resistance from 55 (15) to 38 (14) R units (p < 0.01), a decrease in mean (SD) forearm blood flow from 3.1 (1.2) to 1.8 (0.9) ml.100 ml-1.min-1 (p < 0.01) and an increase in mean forearm vascular resistance from 38 (16) to 62 (24) R units (p < 0.01). Methoxamine 2 mg was administered intravenously when the mean arterial blood pressure decreased by 15%. There was a resultant marked increase in mean (SD) forearm blood flow from 1.8 (0.9) to 3.0 (0.8) ml.100 ml-1.min-1 (p < 0.001) but a decrease in mean (SD) calf blood flow from 2.6 (1.2) to 2.1 (1.4) ml.100 ml-1.min-1 (p = 0.11). Correspondingly, the mean (SD) forearm vascular resistance decreased from 62 (24) to 46 (17) R units (p < 0.01) with an increase in mean (SD) calf vascular resistance from 38 (14) to 56 (22) R units (p < 0.01). These findings indicate that whereas methoxamine produces the anticipated constrictor response in the calf vessels it causes a simultaneous reduction in vascular resistance in the forearm.

摘要

在10名健康患者中，采用静脉阻断体积描记法研究了0.5%重比重布比卡因蛛网膜下腔阻滞对前臂和小腿血流及血管阻力的影响。阻滞之后，小腿平均（标准差）血流从2.0（0.4）增加至2.6（1.2）ml·100 ml⁻¹·min⁻¹（p = 0.057），小腿平均（标准差）血管阻力从55（15）降至38（14）R单位（p < 0.01），前臂平均（标准差）血流从3.1（1.2）降至1.8（0.9）ml·100 ml⁻¹·min⁻¹（p < 0.01），前臂平均血管阻力从38（16）增至62（24）R单位（p < 0.01）。当平均动脉血压下降15%时，静脉注射2 mg甲氧明。结果前臂平均（标准差）血流显著增加，从1.8（0.9）增至3.0（0.8）ml·100 ml⁻¹·min⁻¹（p < 0.001），但小腿平均（标准差）血流从2.6（1.2）降至2.1（1.4）ml·100 ml⁻¹·min⁻¹（p = 0.11）。相应地，前臂平均（标准差）血管阻力从62（24）降至46（17）R单位（p < 0.01），小腿平均（标准差）血管阻力从38（14）增至56（22）R单位（p < 0.01）。这些发现表明，虽然甲氧明在小腿血管中产生了预期的收缩反应，但它同时导致前臂血管阻力降低。