两种浓度氯普鲁卡因用于剖宫产硬膜外麻醉的临床观察

Epidural anesthesia by chloroprocaine for cesarean section

目的观察氯普鲁卡因用于剖宫产硬膜外的麻醉效果。方法选择40例足月孕产妇剖宫产手术者,随机分为A(n=20)、B(n=20)两组,均采用L2～3硬膜外麻醉。A组用2.5%氯普鲁卡因,B组用3%氯普鲁卡因,两组分别一次性自硬膜外腔注入13ml或10.8ml(两组剂量相等)。结果①两组麻醉起效时间〔(1.75±0.55)minvs(1.76±0.37)min〕、切口痛消失时间〔(9.30±1.53)minvs(8.71±1.54)min〕、切口痛恢复时间〔(90.95±40.99)minvs(93.20±32.05)min〕均一致;②两组麻醉止痛效果均完善,无一例需要静脉镇痛药辅助;③两组神经阻滞范围一致,分别为胸5.05±1.19至骶3.40±1.25和胸5.10±0.94至骶3.95±1.10;④下肢运动阻滞程度B组明显强于A组(P<0.01);⑤两组血压、心率变化相对稳定,变化趋势相似,无一例需要缩血管药;⑥对新生儿Apgar评分无明显抑制,未见明显不良反应。结论2.5%和3%氯普鲁卡因用于剖宫产硬膜外麻醉均能产生满意的麻醉效果,无明显不良反应。2.5%浓度对下肢运动阻滞较轻。

Objective To observe the effect of chloroprocaine for epidural anesthesia in cesarean section. Methods Forty primiparas with full-term pregnancy were divided randomly into group A(n=20) and group B(n=20). They accepted 13 ml 3% chloroprocaine or 10.8 ml 2.5% chloroprocaine at lumbar 2 ～ 3 epidural space respectively. Results ① The onset time of anesthesia 〔(1.75 ± 0.55)min vs (1.76 ± 0.37)min〕, incision pain free time 〔(9.30 ± 1.53)min vs (8.71 ± 1.54)min〕 and incision pain returned time 〔(9.30 ± 1.53)min vs (8.71 ± 1.54)min〕 were similar in both groups respectively. ② Effects of anesthesia and analgesia were satisfactory in both groups, none case needed any analgesics. ③ Ranges of nerve block (thoracic 5.05 ± 1.19 ~sacral 3.40 ± 1.25 vs thoracic 5.10 ± 0.94 ~sacral 3.95 ± 1.10) were similar in both groups. ④ Motor blockade effect of the lower limbs in group B were significantly stronger (P < 0.01) than those in group A. ⑤ Blood pressure and heart rate were relatively stable, no one needed vaseactive drug. ⑥ Neonate Apgar scores were not affected. Conclusions 2.5% and 3% chloroprocaine both can produce satisfactory epidural anesthesia for cesarean section, while the 2.5% chloroprocaine has a weaker lower limbs motor blockade.