氯普鲁卡因脊-硬联合麻醉用于妇科手术

Clinical study of chloroprocaine spinal-epidural combining block in patients undergoing 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的效果。方法120例子宫切除患者随机均分为A、B、C、D组，接受脊-硬联合麻醉。各组脊麻用药分别为2．5％CP 1ml＋10％GS（葡萄糖）0．5ml＋3％Eph（麻黄碱）0．5ml、2．5％CP 1．2ml＋10％GS 0．5ml＋3％Eph 0．5ml、2．5％CP 1．4ml＋10％GS 0．5ml＋3％Eph 0．5ml和2．5％CP 1．6ml＋10％GS 0．5ml＋3％Eph 0．5ml。脊麻效果欠佳时则硬膜外用2．5％CP。结果①各组在脊麻起效时间、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T7.2±1.37、T5.85±1.25、T4.37±1.18和L3.30±1.47，差异有统计学意义。②脊麻效果不满意率A、B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组脊麻效果均为极好。③D组低血压发生率较高，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％CP 30mg～35mg脊麻效果理想安全。

Objective To study the clinical efficacy and safety of domestic chloroprocaine （CP） using for spinal-epidural combining block in patients undergoing hysterectomy. Methods 120 patients scheduled for hysterectomy were randomly divided into 4 groups （ each n = 30）. Spinal block was conducted with 2.5 % CP 1.0 ml （ group A ）, 1.2 ml （ group B ）, 1.4 ml （ group C ） or 1.6 ml （group D） plus 10% GS 0.5 ml and 3% ephedrine 0.5 ml. Catheter was then placed into epidural cavity and 2.5% CP was injected for epidural block in the case of unsatisfactory spinal block. Results ①The onset time, the time of getting maximal sensory nerve block and the degrees of motor nerve block of lower limbs （ Bromage grade） were similar for four groups. However, the upper level of sensory nerve block rose along with increase of CP volume （T7.20±1.37, T5.85±1.25, T4.37±1.18 and T3.30±1.47 in groups A, B, C, and D, respectively）. ②Unsatisfactory spinal block occurred in 80% and 16.7% of patients of group A and group B, respectively, and the situation was improved completely with the following epidural block. Single spinal block was able to get an ideal effect in groups C and D, with- out additional epidural block. ③The incidence of hypotension was higher in group D than in other groups and respiratory depression occurred in 9 cases in group D. ④Systemic and spinal nerve toxic responses were not found for all the patients. Conclusion The findings of present study suggest that 30 mg-35 mg of 2.5% CP for spinal block is effective and safe in patients undergoing hysterectomy.