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Anesthesiology:采用升降法来确定鞘内注射布比卡因和芬太尼后预防剖宫产期间低血压发生所需的座位持续时间

2018-01-13 祝瑜 “罂粟花”微信号

背景:鞘内注射重比重的布比卡因和吗啡后的持续坐卧体位与剖宫产术期间低血压发生率有关,但也会使得在腹膜闭合过程中疼痛的发生率高。因此,我们展开了此项研究,以确定鞘内注射芬太尼对坐卧位与低血压及术中镇痛要求之间的关系。

背景:鞘内注射重比重的布比卡因和吗啡后的持续坐卧体位与剖宫产术期间低血压发生率有关,但也会使得在腹膜闭合过程中疼痛的发生率高。因此,我们展开了此项研究,以确定鞘内注射芬太尼对坐卧位与低血压及术中镇痛要求之间的关系。

方  法:接受剖宫产术的妇女随机接受通过腰硬联合技术鞘内注射11.25或15毫克的重比重布比卡因、吗啡150ug和芬太尼15μg。使用升降法分配孕妇鞘内注射后的坐位持续时间。如果前一个病人出现低血压或正常,则下一个病人就坐15秒或坐更短的时间。收缩压小于术前值的80%被定义为低血压;按标准给予孕妇麻醉剂,并且记录手术过程中疼痛的出现情况。用保序回归法对邻近的低血压孕妇进行回归分析,以确定每组中50%的孕妇可避免发生低血压的时间(即有效座位时间中位数)。

结  果:每组15例。11.25mg组的坐位时间中位数为129秒(95%置信区间[CI],116-150),而在15mg组,中位数为459秒(95%CI为444-471)。且本研究的30例患者中只有1例(3%)关腹膜时出现疼痛,并用静脉注射芬太尼治疗成功。

结  论:通过此研究我们确定了鞘内注射重比重布比卡因、吗啡和芬太尼后预防50%孕妇剖宫产术后低血压所需的座位时间。

原始出处:

Sugiyama D,et al.,Hydrogen Peroxide Induces Muscle Nociception via Transient Receptor Potential Ankyrin 1 Receptors.Anesthesiology. 2017 Oct;127(4):695-708.

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    2018-11-02 xiangyuzhou971
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    2018-01-16 1e0f8808m18(暂无匿称)

    学习了.谢谢分享.

    0

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  4. 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GetPortalCommentsPageByObjectIdResponse(id=1367360, encodeId=d650136e36026, content=<a href='/topic/show?id=f4012634656' target=_blank style='color:#2F92EE;'>#低血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26346, encryptionId=f4012634656, topicName=低血压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f634250, createdName=chentianping, createdTime=Mon Jan 15 08:32:00 CST 2018, time=2018-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1384811, encodeId=1f35138481147, content=<a href='/topic/show?id=93918690e81' target=_blank style='color:#2F92EE;'>#芬太尼#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86907, encryptionId=93918690e81, topicName=芬太尼)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Mon Jan 15 08:32:00 CST 2018, time=2018-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1503640, encodeId=112e1503640e0, content=<a href='/topic/show?id=4f215634296' target=_blank style='color:#2F92EE;'>#持续时间#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56342, encryptionId=4f215634296, topicName=持续时间)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=13e29684821, createdName=zhwj, createdTime=Mon Jan 15 08:32:00 CST 2018, time=2018-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545970, encodeId=030315459e00b, content=<a href='/topic/show?id=5d4a48412f1' target=_blank style='color:#2F92EE;'>#布比卡因#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48412, encryptionId=5d4a48412f1, topicName=布比卡因)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=321313846448, createdName=12498c32m72暂无昵称, createdTime=Mon Jan 15 08:32:00 CST 2018, time=2018-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588301, encodeId=4afb158830167, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Mon Jan 15 08:32:00 CST 2018, time=2018-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615715, encodeId=68bf1615e157c, content=<a href='/topic/show?id=c75c9998e5d' target=_blank style='color:#2F92EE;'>#鞘内注射#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99987, encryptionId=c75c9998e5d, topicName=鞘内注射)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c3bb19663119, createdName=zywlvao, createdTime=Mon Jan 15 08:32:00 CST 2018, time=2018-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278204, encodeId=39632e82042b, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Sat Jan 13 21:08:38 CST 2018, time=2018-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278162, encodeId=e8a42e8162f8, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Sat Jan 13 18:21:11 CST 2018, time=2018-01-13, status=1, ipAttribution=)]
    2018-01-15 xue8602
  5. [GetPortalCommentsPageByObjectIdResponse(id=2051022, encodeId=2047205102227, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Fri Nov 02 10:32:00 CST 2018, time=2018-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278919, encodeId=40da2e8919cb, content=学习了.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Tue Jan 16 06:53:45 CST 2018, time=2018-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1367360, encodeId=d650136e36026, content=<a href='/topic/show?id=f4012634656' target=_blank style='color:#2F92EE;'>#低血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26346, encryptionId=f4012634656, topicName=低血压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f634250, createdName=chentianping, createdTime=Mon Jan 15 08:32:00 CST 2018, time=2018-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1384811, encodeId=1f35138481147, content=<a href='/topic/show?id=93918690e81' target=_blank style='color:#2F92EE;'>#芬太尼#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86907, encryptionId=93918690e81, topicName=芬太尼)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Mon Jan 15 08:32:00 CST 2018, time=2018-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1503640, encodeId=112e1503640e0, content=<a href='/topic/show?id=4f215634296' target=_blank style='color:#2F92EE;'>#持续时间#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56342, encryptionId=4f215634296, topicName=持续时间)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=13e29684821, createdName=zhwj, createdTime=Mon Jan 15 08:32:00 CST 2018, time=2018-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545970, encodeId=030315459e00b, content=<a href='/topic/show?id=5d4a48412f1' target=_blank style='color:#2F92EE;'>#布比卡因#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48412, encryptionId=5d4a48412f1, topicName=布比卡因)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=321313846448, createdName=12498c32m72暂无昵称, createdTime=Mon Jan 15 08:32:00 CST 2018, time=2018-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588301, encodeId=4afb158830167, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Mon Jan 15 08:32:00 CST 2018, time=2018-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615715, encodeId=68bf1615e157c, content=<a href='/topic/show?id=c75c9998e5d' target=_blank style='color:#2F92EE;'>#鞘内注射#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99987, encryptionId=c75c9998e5d, topicName=鞘内注射)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c3bb19663119, createdName=zywlvao, createdTime=Mon Jan 15 08:32:00 CST 2018, time=2018-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278204, encodeId=39632e82042b, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Sat Jan 13 21:08:38 CST 2018, time=2018-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278162, encodeId=e8a42e8162f8, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Sat Jan 13 18:21:11 CST 2018, time=2018-01-13, status=1, ipAttribution=)]
    2018-01-15 zhwj
  6. [GetPortalCommentsPageByObjectIdResponse(id=2051022, encodeId=2047205102227, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Fri Nov 02 10:32:00 CST 2018, time=2018-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278919, encodeId=40da2e8919cb, content=学习了.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Tue Jan 16 06:53:45 CST 2018, time=2018-01-16, status=1, ipAttribution=), 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encryptionId=5d4a48412f1, topicName=布比卡因)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=321313846448, createdName=12498c32m72暂无昵称, createdTime=Mon Jan 15 08:32:00 CST 2018, time=2018-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588301, encodeId=4afb158830167, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Mon Jan 15 08:32:00 CST 2018, time=2018-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615715, encodeId=68bf1615e157c, content=<a href='/topic/show?id=c75c9998e5d' target=_blank style='color:#2F92EE;'>#鞘内注射#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99987, encryptionId=c75c9998e5d, topicName=鞘内注射)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c3bb19663119, createdName=zywlvao, createdTime=Mon Jan 15 08:32:00 CST 2018, time=2018-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278204, encodeId=39632e82042b, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Sat Jan 13 21:08:38 CST 2018, time=2018-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278162, encodeId=e8a42e8162f8, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Sat Jan 13 18:21:11 CST 2018, time=2018-01-13, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=2051022, encodeId=2047205102227, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Fri Nov 02 10:32:00 CST 2018, time=2018-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278919, encodeId=40da2e8919cb, content=学习了.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Tue Jan 16 06:53:45 CST 2018, time=2018-01-16, status=1, ipAttribution=), 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beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Sat Jan 13 18:21:11 CST 2018, time=2018-01-13, status=1, ipAttribution=)]
    2018-01-15 skhzy
  8. 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  9. [GetPortalCommentsPageByObjectIdResponse(id=2051022, encodeId=2047205102227, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Fri Nov 02 10:32:00 CST 2018, time=2018-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278919, encodeId=40da2e8919cb, content=学习了.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Tue Jan 16 06:53:45 CST 2018, time=2018-01-16, status=1, ipAttribution=), 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beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Sat Jan 13 18:21:11 CST 2018, time=2018-01-13, status=1, ipAttribution=)]
    2018-01-13 131****1460

    学习了受益匪浅

    0

  10. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Sat Jan 13 18:21:11 CST 2018, time=2018-01-13, status=1, ipAttribution=)]
    2018-01-13 惠映实验室

    学习了.谢谢.

    0

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无痛分娩问答锦集

问1:最佳分娩镇痛药应该是怎么样? 答:1805年本杰明 拉什 (Benjamin Rush) 有过一个梦想 “A medicine would be discovered which should suspend sensibility altogether and leave irritability or powers of motion unimpaired.”(这个药物能阻断感

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