不同浓度、剂量氯普鲁卡因的产科脊麻

Chloroprocaine Used for Spinal Anesthesia in Obstetrics

目的：研究不同浓度，不同剂量氯普鲁卡因用于产科脊麻的效果。 方法：117例经L2-3脊间隙腰-硬膜外联合穿刺麻醉的产妇被随机分为A（n=39）,B（n=40）,C（n=38）三组，分别向蛛网膜下间隙注入（针斜面向尾）氯普鲁卡因合剂：2.5%氯普鲁卡因1.0ml＋10%葡萄糖0.5ml＋3%麻黄碱0.5ml,2.5%氯普鲁卡因1.2ml＋10%葡萄糖0.5ml＋3%麻黄碱0.5ml或3%氯普鲁卡因1.0ml＋10%葡萄糖0.5ml＋3%麻黄碱0.5ml，注射速度35s. 结果：（1）麻醉起效时间C组明显明显快于A组（P〈0.05）。达到胸11无痛时间、双下肢不能抬起时间，最高阻滞平面时间C组均快于A、B两组，但无统计学意义。最高阻滞平面C组（T3.00±0.47）平均高出A（T4.05±1.13），B（T4.50±1.38）组一个节段。（2）麻醉消退至胸11时间、双下肢能抬起时间，麻醉完全消失时间A、B两组相似，而C组明显较长（P〈0.01），（3）三组术中均无产妇诉疼痛，术者感觉腹肌均非常松驰。（4）麻醉后出现低血压（SP〈80 mmHg或下降〉基础值30%）A、B、C三组分别为33%、40%、51%，均给予麻黄碱纠正。心率相对稳定。SpO2正常。（5）麻醉后恶心呕吐随着氯普鲁卡因剂量或浓度的升高而增加。（6）所有受研究者至出院时均未见任何精神神经系统不良反应。 结论：三组国产氯普鲁卡因合剂用于产科脊麻均产生满意的临床麻醉效果，但随着氯普鲁卡因剂量或浓度的增加其产生低血压和恶心呕吐的发生率增加。剖宫产选择氯普鲁卡因脊麻用A组合剂即可。

Objective： To study the efficiency of chloroprcaine in different concentration and dosage used for spinal anesthesia in obstetrics Method： 117 primiparas with full-term pregnancy were divided randomly into group A（n=39）, B（n=40） and C（n=38）, punctured from lumbar 2-3 spinal irterspace, and injected a mixture of 20 ml （2.5% chloroprocaine 1.0 ml,10% glucose 0.5 ml, 3% ephedrine 0.5 ml） or 2.2 ml（2.5% chloroprocaine1.2 ml. 10% glucose 0.5 ml, 3% ephedrine 0.5 ml） or 2.0 ml C3% chloroprocaine 1.0 ml, 10% glucose 0.5 ml, 3% ephedrine 0.5 ml） within 35 seconds into subarachnoid space, respectively. Results： （1）Onset time was significantly faster （P〈0.05） in group C than group A. Time to arrive at thoracic 11 pain-free, time unable to lift up lower limbs. time of the higheai nerve block levels were faster （no significant） in group C than other groups. The highest nerve block mean levels were thoracic 4.5.0±0.31. 4.05±1.38 and 3.00±1.47 in group A, B and C, respectively. （2） Time of nerve block faded to thoracic 11, time able to lift up lowe limbs and time of anesthesia complete disappearance were significantly longer （P〈0.01） in group C than those in ether groups. （3） No one of primiparas in groups complained surgery path, and all primiparas＇ abdomtnal muscles were profoundly relaxation （4） Incidence rates of hypotension in group A, B and C were 33%. 40% and 51%. respectively, and could be effectively corrected by ephedrine. （5） Morbidities of nausea and vomiting were increased with elevation of concentration or dosage of chleraprocaine 16） We did not observe any mal-behavior changes involved in chloroprocaine toxicity. Conclusions; The three mixtures of chloroprocaine can produce satisfactory spinal anesthesia for cesarean, but the side-effects of hypotension and nausea and vomiting are increased with increment in dosage or concentration of chloroprocaina. The mixture of 2.5% chloroprocaine 1.0 ml, 10% glucose 0.5 ml, 3% ephedrine 0.5 ml is enough for spinal anesthesia in cesarean.