Đánh giá tác dụng dự phòng tụt huyết áp của Phenylephrine trong gây tê tủy sống ở phẫu thuật thay khớp háng ở bệnh nhân cao tuổi
Authors: Nguyễn Quang 
Published: May 2023

Đặt vấn đề: Phương pháp gây tê tủy sống đơn thuần có những ưu điểm nổi bật , tuy nhiên tỉ lệ tụt huyết áp ở bệnh nhân cao tuổi trong phẫu thuật thay khớp háng khá cao, từ 40 - 46,67%. Sử dụng thuốc vận mạch dự phòng và điều trị tụt huyết áp trong mổ là một biện pháp vừa hạn chế được lượng dịch truyền cũng như có thể sử dụng đủ liều thuốc tê, đặc biệt là khi kết hợp bù dịch keo và sử dụng thuốc vận mạch dự phòng và điều trị tụt huyết áp. Nghiên cứu của chúng tôi thực hiện với mục tiêu đánh giá tác dụng dự phòng giữa hai nhóm có và không có sử dụng liều dự phòng phenylephrine trong gây tê tủy sống ở phẫu thuật thay khớp háng trên bệnh nhân cao tuổi.

Đối tượng, phương pháp: 100 bệnh nhân cao tuổi (≥ 60 tuổi) được tiến hành phẫu thuật thay khớp háng theo kế hoạch, được chia ngẫu nhiên thành hai nhóm có sử dụng liều dự phòng 50 mcg phenylephrine và không sử dụng liều dự phòng phenylephrine. Phương pháp được thực hiện là nghiên cứu mô tả cắt ngang.

Kết quả: Tỷ lệ tụt huyết áp ở hai nhóm dùng liều dự phòng và không dùng liều dự phòng bằng phenylephrine là 52% và 56% (p = 0.548). Số lần dùng thuốc điều trị tụt huyết áp và liều dùng ở 2 nhóm tương đương nhau.

Kết luận: Liều dự phòng phenylephrine không làm giảm tỷ lệ tụt huyết áp sau gây tê tủy sống trong phẫu thuật thay khớp háng ở bệnh nhân cao tuổi.

ABSTRACT ASSESSMENT THE PREVENTIONS EFFECTS OF PHENYLEPHRINE IN SPINAL ANESTHESIA FOR HIP REPLACEMENT SURGERY ON ELDERLY PATIENTS

Vo Hoang Phu1,2, Nguyen Thanh Xuan1, Nguyen Viet Quang Hien1,3

Background: The method of spinal anesthesia alone has outstanding advantages, but the rate of hypotension in elderly patients in hip replacement surgery is quite high, from 40 to 46.67%. The use of vasopressors to prevent and treat hypotension during surgery is a measure that both limits the amount of fluid as well as can use a sufficient dose of local anesthetic, especially when combining colloidal replacement and drug use. vasopressor for prevention and treatment of hypotension. Our study was conducted with the aim of evaluating the prophylactic effect between two groups with and without the use of prophylactic doses of phenylephrine in spinal anesthesia in hip replacement surgery in elderly patients.

Methods: 100 elderly patients (≥ 60 years of age) undergoing planned hip replacement surgery were randomly divided into two groups with and without a prophylactic dose of 50 mcg phenylephrine. The method used is a cross - sectional descriptive study.

Results: The rate of hypotension in the two groups receiving prophylactic and non- prophylactic doses of phenylephrine was 52% and 56% (p = 0.548). The number of using antihypertensive drugs and the dose in the 2 groups were similar.

Conclusions: Prophylactic doses of phenylephrine can’t reduction in the rate of hypotension after spinal anesthesia in hip replacement surgery in elderly patients.