不同麻醉方法在剖宫产手术中的临床效果对比

The Different Anesthesia Methods in Cesarean Section

目的:探讨小剂量0.75%左旋布比卡因腰麻硬膜外联合阻滞(CSEA)和3%氯普鲁卡因硬膜外阻滞在剖宫产手术中的临床效果,评价其安全性和可行性。方法:足月初产妇120例随机双盲分成三组:研究组为A组和B组,对照组为C组。A组(n=40)蛛网膜下腔阻滞麻醉用药为0.75%左旋布比卡因10mg,使用腰麻硬膜外联合阻滞行剖宫产术,B组(n=40)以3%氯普鲁卡因为硬膜外麻醉的局麻药,使用硬膜外麻醉阻滞行剖宫产术,C组(n=40)腰麻用药为0.75%布比卡因10mg,使用腰麻硬膜外联合阻滞行剖宫产术。术中A.C两组麻醉效应不足时经硬膜外导管补充2%利多卡因。术中连续监测生命体征,评估麻醉效应,并观察新生儿情况。结果:三组的感觉阻滞效应,包括起效时间、痛觉消失、运动阻滞时间快等优点。最高阻滞平面相比基本相似(P>0.05);三组的运动阻滞到达BromageI级和BromageIII级的时间相比较,差异无统计学意义(P>0 05);术中肌松效果,A.B组38例(95%)优,C组39例(97.5%)优,组间差异无统计学意义(P>0.05);术中A,B,C组各有3例产妇发生低血压(P>0.05);A组产妇发生心动过缓2例,B组有3例,C组有2例,(P>0.05),新生儿Apgar评分:1 5min评分均为10分,组间比较差异无统计学意义(P>0.05)。结论:0.75%左旋布比卡因腰麻硬膜外联合阻滞下的感觉和运动阻滞效应与3%氯普鲁卡因硬膜外阻滞相似,用于剖宫产手术中安全有效。

Objective：To investigate the effect and safety of small dosage 0.75% levobupivacaine for CSEA and 3% chloroprocaine the hard membrane pericoel hinders the anaesthesia in splits the palace to produce in the surgery. Method： Full -term pregnancy of primipara 120 cases of illness. Stochastic double divides into three groups ： research of group - A group and B group . control group of C group , A group （ n = 40 ）, 0.75 % levobupivacaine 10mg for CSEA, B group （n=40） , 3% chloroprocaine the hard membrane pericoel hinders, C group ： 0.75 % bupivacaine for under the arachnoidea the cavity hinders the anaesthesia, In surgery process, to A and B groups,2% lidocaine were intermittently injected respectively by epidural cathete, effec not enough of anesthesia. Observe the change of life - support system; in technique continuous, To observe effect of anesthesia and neonatus. Result： Three groups ： effect of anesthesia for sensation ; fast of merit include： starts to have the effect time. Pain vanishing rime,movement function vanishing time. The circulation changes were similar in three groups before and after anesthesia（P 〉 0.05） , neonatus Apgar grade： Result grading is 10at 15min. （P 〉0.05 ）. Conclusion：The circulation changes were similar in two groups before and after anesthesia for 0.75% levobupivacaine for CSEA and 3% chloroprocaine the hard membrane pericoel hinders the anaesthesia in splits the palace to produce in the surgery. It is effective and safe and can be used widely.