Effect Of Methoxamine On Cardiovascular Response In Patients With Cesarean Section Caused By Oxytocin

Objective:Select a combination of spinal and epidural anesthesia to observe whether methomycin can offset the oxytocin induced cesarean section maternal cardiovascular adverse reactions to clear the best treatment strategy of methomyl and its evaluation in the obstetric anesthesia oxytocin after use The application value and advantages.Methods:?we choose 120 patient needed for caesarean section of the maternal,and pregnant as single-fetus full-term pregnant women.ASA grade I to grade II.?All the subjects were randomly divided into the group consisting of methoxazole0.01 mg / kg group(M1 group),methomycin 0.02 mg / kg group(M2 group),methomycin 0.03 mg / kg group(M3 group)and control group(group C),Each group of 30.?After entering the operating room,the following vital signs are monitored: blood pressure(BP),heart rate(HR),electrocardiogram(ECG),and pulse oximetry(Sp O2).Intravenous infusion of compound sodium chloride injection 8-10 ml / kg before anesthesia.? To help patients to change the position of the left lateral position,select the puncture point for the L2,3 into the spinal anesthesia and into the epidural catheter.The sensory plane is controlled at T7,8 before starting the surgery.?10 units of oxytocin is injected rapidly by small pot when the baby is delivered,M1 group,M2 group and M3 group were intravenous injection of methacin 0.01 mg / kg,0.02 mg / kg,0.03 mg / kg(10mg methoxamine into the normal saline diluted to 20 ml,0.5mg / ml),the control group(Group C)did not give any vasoconstrictor.Hypotension was defined as a decrease of> 20% after administration of oxytocin;Hypertension was defined as a 20% increase in blood pressure before administration of oxytocin.When SBP than oxytocin decreased by ? 30% before administration,intravenous injection of methamphetamine 1-2mg;When the tachycardia(HR> 100 times / min)occurs,accelerating the infusion of intravenous and injection of esmolol 10-20mg;When cardiac tachycardia(HR <50 beats / min)occurs,atropine is given 0.3-0.5 mg.If the patient in the oxytocin after the occurrence of the above situation will be removed from the observed object.?We will record SBP,DBP and HR include injection oxytocin(T1),1 min(T2),3 min(T3),5 min(T4)and 10 min(T5).At the same time we record nausea,vomiting,hypotension and other adverse reactions.Results:1.Compared with group C,there was no significant difference in age,body weight,operation time,infusion volume,bleeding volume and urine volume between M1 group,M2 group and M3 group(P> 0.05).2.Comparison of hemodynamic parameters:(1)Methoxamine 0.02 mg / kg group(M2 group)can be significantly alleviated by oxytocin concomitant decrease systolic blood pressure.M1 group,M2 group,M3 group and C group of four groups of systolic blood pressure comparison:Comparison between groups:There was no significant difference in the systolic blood pressure between the four groups(P> 0.05).Compared with the C group,the M2 group and the M3 group were significantly increased at T2-T4,the difference was statistically significant(P <0.05).Group internal comparison:In the control group(group C): T2,T3,T4 and T1 were significantly decreased(P <0.05).In the group of methoxamine 0.01 mg / kg(group M1): T2,T3,T4 and T1 were significantly decreased(P <0.001);In the group of methoxamine 0.02 mg / kg(group M2): there was no significant difference between T2-T5 and T1(P> 0.05),systolic blood pressure was small;In the group of methoxamine0.03 mg / kg(group M3):T3,T4 and T1 were significantly increased(P <0.05).(2)Methoxamine 0.02 mg / kg group(M2 group)can significantly alleviate the reduction of diastolic blood pressure associated with oxytocin.M1 group,M2 group,M3 group and C group of four groups of diastolic blood pressure comparison:Comparison between groups:There was no significant difference in diastolic blood pressure between the four groups(P> 0.05).Compared with group C,the M2 group and M3 group were significantly increased at T2-T4,the difference was statistically significant(P <0.05).Group internal comparison:In the control group(group C): T2,T3,T4 and T1 were significantly decreased(P <0.001);In the group of methoxazole 0.01 mg / kg(group M1):T2,T3,T4 and T1 were significantly decreased(P <0.05).In the group of methoxamine 0.02 mg / kg(group M2):T2-T5 and T1 compared to no significant difference(P> 0.05),diastolic blood pressure smaller;In the group of methoxamine 0.03 mg / kg(group M3):T3?T4 and T1 were significantly increased(P <0.05).(3)Methoxazole 0.02 mg / kg group(M2 group)can significantly alleviate the increase in heart rate associated with oxytocin.M1 group,M2 group,M3 group and C group of four groups of heart rate comparison: Comparison between groups:At T1,there was no significant difference in heart rate between the four groups(P> 0.05).Compared with control group(group C),the heart rate of methoxamine 0.01 mg / kg group(M1 group),methoxamine 0.02 mg / kg group(M2group)and methoxamine 0.03 mg / kg group(M3 group)T2 and T3 were significantly decreased(P <0.001).Group internal comparison:In the control group(group C): T2,T3 were significantly increased compared with T1(P <0.001);In the group of methoxamine 0.01 mg / kg(group M1):T3 was significantly increased compared with T1(P <0.05).In the group of methoxamine 0.02 mg / kg(group M2):There was no significant difference between T3-T5 and T1(P> 0.05).In the group of methoxamine 0.03 mg / kg(group M3):T3 was significantly increased compared with T1(P <0.05).3.Methoxamine 0.02 mg / kg group(M2 group)occurred less adverse reactions.M1 group,M2 group,M3 group and C group of four groups of adverse reactions:(1)Compared with the control group(group C),The incidence of nausea was decreased in the group of methoxamine 0.02 mg / kg(M2)(P <0.05);The incidence of hypotension was reduced(P <0.05).The incidence of nausea was reduced(P <0.05)in the group of methoxamine 0.03 mg / kg(M3);The incidence of hypotension was reduced(P <0.05).(2)Compared with methoxamine 0.01 mg / kg group(M1 group),the incidence of adverse reactions was decreased in the group of methoxamine 0.02mg/kg(M2)(P<0.05);Methoxamine 0.03 mg / kg group(M3 group)decreased the incidence of adverse reactions(P <0.05).(3)There was no significant difference in the incidence of adverse reactions between the group consisting of methoxamine 0.02 mg / kg group(M2 group)and methoxamine0.03 mg / kg group(M3 group)(P> 0.05).(4)The incidence of hypertension and bradycardia in the group of methoxamine0.03 mg /kg group(M3 group)was higher than that in M1 group,M2 group and C group(P<0.05).Conclusion:1.The patients of cesarean section with spinal anesthesia,different doses of methoxamine can significantly increase the oxytocin-induced systolic and diastolic blood pressure and reduce oxytocin-induced increase in heart rate,suggesting that methoxamine Can effectively reduce the cesarean section in patients with oxytocin caused by cardiovascular adverse reactions.2.Methoxamine dose of 0.01,0.02 and 0.03 mg / kg can reduce oxytocin associated with adverse reactions,and 0.02 mg / kg effect is better than 0.01 mg / kg and 0.03 mg / kg,suggesting that we in clinical application of a Oxygen resistance to oxytocin caused by adverse reactions and associated with the appropriate dose of 0.02 mg / kg.