重比重与等比重布比卡因在腰麻剖宫产术中的比较

Clinical comparation between hyperbaric and normobaric bupivacaine lumbar anesthesia in cesarean section

目的比较等比重、重比重布比卡因腰麻在剖宫产手术中的麻醉效果,探讨重比重腰麻在剖宫产术中的可行性。方法选择70例ASA分级Ⅰ~Ⅱ级的剖宫产患者,随机分为2组：Z组（重比重腰麻组）：0.75%布比卡因2 mL＋10%葡萄糖1 mL;D组（等比重腰麻组）：0.75%布比卡因2 mL＋0.9%生理盐水1 mL,分别记录腰麻起效时间,达到最高平面所需时间,最高镇痛平面,及术中并发症发生情况。结果Z组腰麻起效时间明显较D组快（P〈0.05）,Z组最高镇痛平面较D组高,Z组镇痛和运动阻滞维持时间明显长于D组（P〈0.05）。术中发生低血压、恶心呕吐、呼吸困难等不良反应,两组无显著性差异。结论在平卧位下,重比重布比卡因麻醉效果明显优于等比重组,腰麻质量可靠,可安全地用于剖宫产患者的麻醉,尤其适用于急诊剖宫产。

Objective To confirm the feasibility of hyperbaric bupivacaine spinal anesthesia in cesarean section by comparing the differences of anesthesia effects between the normobaric and hyperbaric lumbar anesthesia. Methods 70 ASA stage Ⅰ-Ⅱ patients undergoing cesarean section were randomly divided into two groupa; Z group （hyperbaric spinal anestheria group） ： 0.75% bupivacaine 2 mL＋ 10% glucose 1 mL;D group （normobaric spinal anestherla group）：0.75% bupivacalne 2 mL＋ normal salt water 1 mL. The onset time of lumbar anesthesia, the time to max.i-level plane, maximum anelgesia plane, and the complications during operation were recorded. Results Z group presented a shorter onset time than D group （ P 〈 0.05 ）, maximum anelgesia plane was higher in Z group, but the anelgesia and rnovetive anesthesia maintaining time was longer in Z group （P〈 0.05）, There was no obvious difference between two groups in complications such as hypotension, nausea, vomitting and dyspnea during operation. Conclusion The anesthesia effects of hyperbaric bupivacaine are better than normobaric, it is reliable and can be used in cesarean section, especiany in emergency cesarean section safely.