国产氯普鲁卡因用于剖宫产脊麻

Spinal anesthesia with chloroprocaine in obstetrics

目的 探讨国产氯普鲁卡因脊麻的可行性和安全性。方法 40例产妇经L2～3行脊麻-硬膜外联合穿刺，向蛛网膜下隙注入氯普鲁卡因脊麻合剂（2.5％氯普鲁卡因1．2ml＋10％葡萄糖0．5m1＋3％麻黄碱0．5ml）2．2ml／30-40s。结果 （1）麻醉起效时间、T11无痛时间、双下肢不能抬起时间、达到最高阻滞平面的时间分别为（22．78±9．52）s、（3．65±0．86）、（3．67±0．73）和（8．04±1．11）min；最高阻滞平面为T4.05±1.38；麻醉消退T11开始疼痛时间、双下肢能抬起时间、麻醉完全消失时间分别为（54．75±8．60）、（68．63±13．22）和（77．50±16．97）min。（2）术中产妇无诉痛，腹肌松弛。（3）麻醉后出现低血压反应17例（42.5％），出现时间（5.21±1.67）min，给予麻黄碱15mg后均好转。心率相对稳定。SpO2正常。（4）麻醉后恶心22例（55％），其中12例（30％）发生在切开子宫前，与低血压有关，其他与手术操作有关；呕吐16例（40％），娩胎前5例，娩胎后11例。（5）麻醉后及其术后1个月内未见任何精神神经系统不良反应。（6）氯普鲁卡因脊麻合剂pH值和比重分别为6．12±0．46，1．012±0．003。结论 产氯普鲁卡因可安全有效地用于脊麻。

Objective To study the possibility and safety of domestic chloroprocaine used for spinal anesthesia. Methods Fourty primiparas were punctured at lumbar 2-3 spinal interspace and injected a 2.2 ml mixture （2.5% chloroprocaine 1.2 ml, 10% glucose 0.5 ml, 30% ephedrine 0. 5 ml） within 30-40 seconds into subarachnoid space. Results （1） The onset time, thoracic 11 pain-free time,the time when lower limbs were unable to lift up,and the time of reaching to the highest nerve block level were （22.78±9.52） s,（3.65±0.86）, （3.67±0.73） and （8.04±1.11） min, respectively. The highest nerve block mean level were thoracic 4. 05 ± 1.38. The time of nerve block fade to thoracic 11, time of lower limbs being able to lift up and time of anesthesia complete disappearance were （54.75±8.60） ,（68.63±13.22） and （77.50±16.97） min, respectively. （2） None of primiparas complained surgical pain, and primiparas＇ abdominal muscles were highly relaxed. （3） Hypotensions occurred at mean time（5.21 ± 1.67） min in 17 cases （17 %） after anesthesia, and were effectively corrected by ephedrine. （4） Nausea and vomiting were 22 （55%） cases, of which 12 （30%） were associated with hypotension, and 16 （40 %）, respectively, during anesthesia and operation. （5） We could not any observe systemic and spinal nerve toxic responses. （6） pH and specific gravity of the mixture were 6.12±0.46 and 1. 012±0. 003, respectively. Conclusion 2.50% chloroprocaine can be used safely and effectively for spinal anesthesia.