Di Roio C, Védrinne J M, Hoen J P, Magnin C, Lansiaux S, Bel J C, Motin J
Département d'anesthésie-réanimation, hôpital Edouard-Herriot, Lyon, France.
Ann Fr Anesth Reanim. 1997;16(5):483-7. doi: 10.1016/s0750-7658(97)83341-2.
To assess the efficacy of intramuscular ephedrine for prevention of hypotension following subarachnoid block (SB) in the elderly.
Prospective, randomized double blind study vs placebo.
Twenty patients, aged 60 years or more, of physical class ASA 2 or 3, scheduled for surgical fixation of fractured neck of femur under SB, allocated into two groups of ten each.
After oral premedication with hydroxyzine 50 mg, 90 min before surgery, and preloading with cristalloid solution 10 mL.kg-1, the subarachnoid space was punctured with the patient in lateral position using a 22 Gauge spinal needle at the L3-L4 or L4-L5 interspace. Patients were given 0.5% hyperbaric bupivacaine intrathecally, according to body weight. Patients in ephedrine group received intramuscular ephedrine 30 mg immediately after SB. Patients in placebo group received 1 mL of intramuscular saline immediately after SB. When blood pressure decreased below 100 mmHg repeated bolus of ephedrine 6 mg were given intravenously.
Patients in both groups experienced a significant decrease in systolic pressure after SB, the decrease being significantly greater in the placebo group.
Prophylactic intramuscular ephedrine is effective to prevent hypotension associated with SB in the elderly.
评估肌内注射麻黄碱预防老年人蛛网膜下腔阻滞（SB）后低血压的疗效。
前瞻性、随机双盲研究，与安慰剂对照。
20例年龄60岁及以上、美国麻醉医师协会（ASA）身体状况分级为2或3级、计划在蛛网膜下腔阻滞下行股骨颈骨折手术固定的患者，分为两组，每组10例。
术前90分钟口服50mg羟嗪进行术前用药，并预充10mL/kg晶体溶液，患者侧卧位时，使用22G脊髓穿刺针在L3-L4或L4-L5椎间隙穿刺蛛网膜下腔。根据体重给患者鞘内注射0.5%重比重布比卡因。蛛网膜下腔阻滞后，麻黄碱组患者立即肌内注射30mg麻黄碱。安慰剂组患者在蛛网膜下腔阻滞后立即肌内注射1mL生理盐水。当血压降至100mmHg以下时，静脉重复注射6mg麻黄碱。
两组患者蛛网膜下腔阻滞后收缩压均显著下降，安慰剂组下降幅度更大。
预防性肌内注射麻黄碱可有效预防老年人蛛网膜下腔阻滞相关的低血压。
