低浓度利布合剂硬膜外麻醉行剖宫产术的临床观察

A Clinical Study of Low-does Lidocaine Plus Bupivacaine Mixture in Epidural Anesthesia for Caesarean Section.

目的：评价低浓度的布比卡因和利多卡因合剂用于硬膜外麻醉行剖宫产术的临床效果和不良反应。 方法：ASA Ⅰ-Ⅱ级行剖宫产术患者60例，随机分为BL组和L组，每组30例。BL组局麻药为0.75%布比卡因和2%利多卡因混合液；L组为2%利多卡因，每组内含盐酸肾上腺素5μg·m^-1。取L2-3椎间隙行硬膜外穿刺向上置管3-4cm，分次给药，至麻醉平面达第八胸神经（T8）。术中观察血压、心率、心电图、氧饱和度、测定感觉阻滞及下肢运动阻滞效果。观察记录不良反应及新生儿评分。 结果：感觉阻滞最高平面、中位数相似，麻醉达T8所需时间，BL组平均14.06min，快于L组平均17.20min（P〈0.05）。术中疼痛评分BL组镇痛效果优于L组（P〈0.005）。手术结束时Bromage评分BL组优于L组（P0.05）。新生儿Apger评分提示两组新生儿无显著差异。心动过速、恶心、呕吐、寒颤发生率两组亦无显著差异。结论：低浓度的布比卡因和利多卡因合剂用于硬膜外麻醉剖宫产术，具有麻醉用药最小，浓度低、镇痛效果好、产妇舒适，母婴安全，可作为剖宫产的麻醉方法之一。

Objective： To observe the effects and side effects of low-does lidocaine plus bupivacaine mixture in epidural anesthesia for caesarean section. Methods： Sixty parturtants （ASA Ⅰ-Ⅱ） scheduled for elective cesarean section were randomly allocated into two groups： Patients in group SL were given 0.75% bupivacaine plus 2% lidocaine mixture, or in group L were given 2% lidocaine with 5μg·m^-1 epinephrine in each group, each group included 30 patients. In all patients epidural space L2-3 was punctured and the catheter was put upward 3-4cm Local anaesthetic agents were administered until a complete sensory block was established extending upper the eighth thoracic nerves （T8）. BP , ECG , SpO2, sensory block and motor block, neonatal OUtcome and side effects were observed and recorded during operation. Results： There were no signfficnt difference in ECG, SpO2, the maximum cephalic sensory block spread, and Apgar scores for neonatus. The onset time of analgesia to T8 were shorter in group BL than group L （P〈0.05）. The scores of intraoparative pain were significantly better in group BL than that in group L （P〈0.005）. Motor nervous block were weaker in group BE At 10 rain after epidural block. SBP and DBP were decreased significantly （P〈0.05）. There were no significant difference in the side effects （tachycardia, nausea, vomiting and shivering）. Conclusions： Epidural administration of low-does lidocaine plus bupivacaine mixture can be applied safety and effectively to cesarean section, has no complications for neonatus.