剖宫产产妇硬膜外腔注药后压力与扩散速度及用药量的关系

Characeristics of epidural pressure,spread and dosage of local anesthetics during epidural block for pregnant women undergoing selective cesarean section

目的探讨择期剖宫产产妇硬膜外腔注药后的硬膜外腔压力、扩散及用药量特征。方法择期剖宫产手术(O组)和择期开腹妇科手术(G组)患者各30例,均于L1～2间隙硬膜外腔穿刺置管。每隔5分钟硬膜外腔以0.5 ml/s速度泵注0.75%罗哌卡因5 ml,共3次。观测并记录两组每次注射后1、3、5 min的硬膜外腔压力(EP),测量末次给药15 min后阻滞平面,计算脊髓节段阻滞用药量(SV)。结果两组硬膜外腔注药后各时点的压力和扩散速度差异无统计学意义。O组SV为(1.27±0.05)ml,明显少于G组的(1.46±0.04)ml(P<0.05)(减少了11.8%)。结论择期剖宫产产妇注药后EP和局麻药扩散速度与非孕妇相仿。达到相同的阻滞平面,剖宫产硬膜外用药量可比非孕妇减少11.8%。

Objective To study the eharaceristics of epidural pressure, spread and dosage of local anesthetics during epidural block for pregnant women undergoing selective cesarean section. Methods Thirty pregnant women undergoing selective cesarean section （group O） and thirty nonpregnant women undergoing gynecological surgery （group G） were given epidural block. Five ml of 0.75% ropivacaine was pumped in a rate of 0.5 ml/s at first time and injected twice in an interval of 5 rain into the epidural space via epidural catheter. The epidural pressure （EP） was measured at 1,3, and 5 min after the infusion. Anesthetic plane was checked and local anesthitic amount per spinal segment（SV） was calculated at 15 min after the final injection. Results There were no significant differences in EP and spread speed between the two groups. The SV of group O was （1. 27±0.05） ml,which was significantly less than （1.46±0. 04）mt in group G （P〈0.05）. Conclusion The EP and anethetic spread of pregnant women undergoing selective cesarean section under epidural block are similar to those of nonpregnant women,but the local anesthitic amount per spinal segment is reduced about 1l. 8%.