不同浓度、剂量布比卡因用于剖宫产脊麻的效果比较

Effects of Bupivacaine in different concentration and dosage for spinal anesthesia in obstetrics

目的 研究比较不同浓度、剂量，等比重布比卡因对产妇的麻醉效果及新生儿的影响，为临床麻醉提供参考依据。方法 选择ASAⅠ～Ⅱ级初次足月妊娠拟择期剖宫产手术孕妇80例，随机分为A、B二组，每组各40例。均在左侧卧住下行腰-硬联合穿刺，L2-3，进针，见脑脊液外流后，针斜面向下注入等比重布比卡因：A组：8mg（0．5％，1．6ml；配法：0．75％布比卡因2ml＋脑脊液1ml）；B组：9．6mg（0．6％，1．6ml；配法：0．75％布比卡因2ml＋脑脊液0．5ml），20s注药完毕。记录麻醉前（基础值）和脊麻注药后1、3、5、7、10、15min各时间点的平均动脉压（MAP）、心率（HR）、脉搏血氧饱合度（SpO2）。测定并记录麻醉起效时间、平面固定时间、最高麻醉平面．最（胸，T）、麻醉完全消退时间、下肢阻滞的最大程度、麻醉并发症等。结果 A组感觉阻滞起效时间长于B组（69．27±21．48 vs 52．43±27，61s，P〈0．05）；两组最高阻滞平面（T4．50±1．44vsT4，10±0．57）及最高阻滞平面的固定时间（7．69±1．36VS7．35±1．22min）相似（P〉0，05）。A组麻醉完全消退时间快于B组（218．40±18，57VF,256．22±16．72min，P〈0．05）；Bromage评分A组明显小于B组（2．03±0．68vs2，93±0．21，P〈0．05）；麻醉后B组低血压发生率明显高于A组（P〈0．05）。两组病人的麻醉效果均优，肌松满意。所有新生儿的Apgar评分均在7分以上，无组间差异。结论 两组病人均产生了良好的脊麻效果，权衡利弊剖宫产脊麻时应用8mg（0．5％，1．6ml）布比卡因更为安全合理。

Objective To study the effects of Bupivacaine in different concentration and dosage used for spinal anesthesia in obstetrics. Methods Eighty primiparae with full - term pregnancy undergoing elective caesarean section were randomly divided to two groups （ n = 40, per group）, and the patients were punctured from lumbar 2 - 3 spinal interspace, and injected an isobaric mixture of h 6ml（ In group A,0. 5% bupivacain 8mg;In group B,0. 6% bupivacain 9. 6 mg） within 20 seconds into subarachnoid space respectively. Hemodynamic changes and patientstesponses were observed perioperatively. After subarachnoid injection,we recorded the time of onset and motor block, the peak sensory blocked level,the modified Bromage scale,the time of recuperating the function of urination and some complications. Results Onset time was significantly faster in group B than that in group A （52.43 ± 27, 6] vs 69. 27 ± 21. 48 s, P 〈 0. 05）. Time of the highest nerve block levels and the mean levels of the highest nerve block were similar in the two groups （no significant, P 〉 0. 05） Time of complete anesthesia disappearance were much longer in group B than in group A （256. 22 ± 16. 72 vs21.8.40 ± 18.57 min,P〈0. 05）. The modified Bromage scale was higher in group B than in group A（2. 93 ±0. 21 vs 2.03 ±0.68,P 〈0.05）. Incidence rates of hypotension were higher in group B than in group A（ P〈0. 05）. The two mixtures of Bupivacaine can produce satisfactory spinal anesthesia for cesarean, and Apgar score of all the neonates ≥7. Conclusions The side-effects of hypotension increased with increment in dosage or concentration of Bupivacaine. The mixture of 0. 5% Bupivacaine 1. 6ml （Smg） is enough for spinal anesthesia in cesarean.