氯普鲁卡因脊-硬联合麻醉用于妇科手术

Clinical Study of Spinal-epidural Anesthesia with Chloroprocaine for Hysterectomy

目的：探讨国产氯普鲁卡因（CP）脊-硬联合麻醉用于妇科手术。 方法：120例子宫切除患者随机均分为A．B、C、D四组接受脊-硬联合麻醉。四组脊麻用药分别为25％CP1ml＋10％GS（葡萄糖）0.5ml＋3％Eph（麻黄碱）0.5ml．2.5％CP1.2ml＋10％GS0.5ml＋3％Eph0.5ml、25.%CP1.4ml＋10％GS0.5ml＋3％Eph0.5ml和25％CP1.6ml＋10％GS0.5ml＋3％Eph0.5ml。脊麻效果欠佳则硬膜外用25％CP。 结果：（1）四组在脊麻起效时间、达到最高阻滞平面时间、下肢阻滞程度上相似，但在阻滞范围上依次增加平均分别为T7.20±1.37,T5.85±1.25、T4.37±1.18和T3.30±1.47，有显著性差异。（2）脊麻效果不满意率A、B两组分别为80％和16.7％,但在硬膜外追加2.5％CP后不满意率消失。C．D两组脊麻效果均为极好。（3）D组低血压发生率、恶心呕吐发生率较高，并有9例呼吸困难。（4）未见全身及脊神经不良反应。 结论：妇科子宫切除手术选用2.5％CP30～35mg脊麻效果理想安全。

Objective： To study clinical efficacy and safety of domestic chloroprocaine （CP） for gynecologic surgery. Methods： 120 gynecologic patients scheduled for hysterectomy were divided randomly into group A（n=30）, B（n=30）, C（n=30） and D（n=30）, and punctured from lumber 2-3 spinal interpace and injected a mixture of spinal anesthesia, which was 2.5% CP 1.0ml ＋ 10% glucose （GS） ＋ 3% ephedrine （Eph） 0.5ml or 2.5% CP 1.2ml ＋ 10% GS ＋ 3% Eph 0.5ml or 2.5% CP 1.4ml ＋ 10% GS ＋ 3% Eph 0.5ml or 2.5% CP 1.6ml ＋ 10% GS ＋ 3% Eph 0.5ml, respectively. It would be performed to use 2.5% CP for epidural space when spinal anesthesia could not satisfy the surgical needs. Results： （1） They were similar in onset time, time of getting to the highest sensory nerve block and degrees of motor nerve block of lower limbers （Bromage grade） among four groups. But the ranges of sensory nerve block were increased in order, mean values of each group were T7.20±1.37, T5.85±1.25, T4.37± 1.18 and T3.30±1.47, respectively. （2） Unsatisfactory incidence rates of spinal anesthesia effect were 80% and 16.7% in group A and B, respectively, so that the those patients needed immediately epidural anesthesia. Spinal anesthesia effecte were very satisfactory in sensory pain in group C and D. （3） Compared with other groups, incidence rates of hypotension, nausea and vomiting were higher, and respiratory depression occurred in 9 cases in group D. （4） we could not observe any systemic and spinal nerve toxic responses. Conclusion： It is efficacy and safety to use 2.5% CP 30-35mg for spinal anesthesia in hysterectomy.