硬膜外阻滞两种给药方式子宫切除术麻醉效果的比较

Coparison of two injection methods of epidural anesthesia in uterectomy

目的: 硬膜外注入 0. 75%丁哌卡因后置管与置管后注药子宫切除术麻醉效果比较。方法: 60例子宫切除术患者, 37~56岁, 50~112kg, ASAI^II级, 随机分成A、B两组各 30例。L2~3硬膜外穿刺成功后, A组注入 0 .75%丁哌卡因 4ml和B组注入 1%利多卡因 4ml各加入 20μg肾上腺素作为实验量然后向头端置管 4cm, 平卧后各注入局麻混合液 (1 6%利多卡因 +0 .2%丁卡因+1 /20万肾上腺素) 初量, 术中酌情 40~50min注入追加量 3~6ml, 维持阻滞平面T8 以上。对比观察两组局麻药用量, 血压和心率变化, 感觉和运动阻滞和不良反应。结果: A组与B组相比, 局麻药用量少 (P<0 .01), 血液动力学变化较轻 (P<0 .05), 感觉和运动阻滞较完善, 肌松满意和不良反应轻。结论: 置管前注入 0 .75%丁哌卡因 4ml硬膜外阻滞子宫切除术的麻醉血液动力学较稳定, 安全有效并能达到较完善的麻醉效果。

Objective:To investigate the anesthesia effects of a prior epidural injection of 0.75% bupivacaine to epidural insertion compared with direct epidural insertion for injecting local narcotics in uterectomy.Methods:Sixty patients, ASA classI^II, aged 37~56 yr, weighed 50~112kg,undergoing uterectomy, were randomly divided into group A(n=30)and group B(n=30).In all patients the epidural space L_ 2~3 was selected, then the catheter was inserted upward 4 cm.0.75% bupivacaine 4ml or 1% lidocaine 4ml plus 20ug epinephine each as a“test dose” was injected prior to epidural insertion in A or B group, and then the patients would receive sequential mixture of 1.6% lidocaine and 0.2% tetracaine with 1/200000 epinephine as the initial volume, 3~6 ml was administered incrementally over a 40~50 min period, sensory blockate to the T_8 or T_6 level was established.The local anesthetic, blood pressure and heart rate, the spread level of analgesic and motor block,bromage score and RAM score,and adverse events were observed and compared.Results:The epidural anesthesia of a prior injection of 0.75% bupivacaine had fewer narcotics(P<0.01), less change of blood pressure and heart rate(P<0.05), better motor block and muscle relaxation and fewer adverse events.Conclusion:A prior epidural injection of 0.75% bupivacaine has less hemodynamics change and is safe and effective for the anesthesia in uterectomy.