剖宫产手术腰硬联合麻醉腰麻布比卡因最适剂量的探讨

Doses of spinal bupivacaine in combined spinal-epidural anesthesia for cesarean section

目的：探讨剖宫产手术中腰麻液布比卡因的最适剂量。方法：360例剖宫产患者随机分为4组，每组90例，腰麻布比卡因剂量A组4mg，B组6mg，C组8mg，D组10mg。记录术前及注药后5min、10min、15min、30min的血压（BP）、心率（HR）以及腰麻平面固定后的绝对平面和相对平面，绝对平面低于1、8者通过硬膜外导管推入1．6％利多卡因并记录推入的数量（ml），BP〈基础值30％或收缩压（SBP）〈90mmHg时静注麻黄素5～10mg，并记录麻黄素的用量（mg）。结果：A组麻醉平面较低，需加入较大量的利多卡因才能满足手术的需要，与其它三组相比差异有显著性（P〈0．05），D组麻醉平面过高，BP，HR变化剧烈，需加用较多的麻黄素以维持BP、HR的稳定，与其它三组相比差异有显著性（P〈0．05），B、C两组麻醉平面适宜，BP、HR稳定，硬膜外加入少量的利多卡因，能取得满意的麻醉效果。结论：剖宫产手术时腰麻布比卡因剂量6～8mg能维持血流动力学稳定，又能很好的满足手术要求。

Objective：To compare the effects and safes of different doses of spinal hyperbaric bupivacaine during combined spinal - epidural anesthesia for elective cesarean section. Methods ：360 term parturients undergoing cesarean scction were randomly divided into 4 groups （n = 90 each） and received spinal hyperbaric bupivacaine 4mg （group A）, 6mg （group B）, 8mg （group C） , 10mg （group D）, respectively. Intravenous ephedrine would be given to treat hypotension. If the blocked scusory level were below Ts in 10 minutes, 1.6% epidural lidocaine would be injected. BP, HR, SPO2 were monitored every, 5 minutes, blocked sensory level, the volume of epidural lidocaine supplementation, the dose of ephedrine required, and tbe satisfaction of surgeon were recorded. Results ： The blocked sensory level of group A was lower and required significantly more epidural lidocaine （ P 〈 0.05 ）. The blocked sensory level in group D was too high to make BP, HR change severely, and requited significantly more dose of intravenous ephedrine （ P 〈 0.05 ）. The blocks in group C and group D were reliable, BP, HR were stable, little epidural lidocaine were required, and the surgeons were satisfied. Conclusion ：6 -8mg spinal hyperbaric bupivacaine can provide a more reliable and safer block in combined spinal -epidural anesthesia for the term parturients undergoing elective cesarean section.