布比卡因脊麻和硬膜外阻滞用于剖宫产麻醉的临床观察

Clinical observation on intrathecal and epidural bupivacaine in cesarean section

目的:观察布比卡因硬膜外麻醉和布比卡因重比重腰麻用于剖宫产手术的麻醉效果,以及对患者和胎儿的影响。方法:选择行择期剖宫产手术患者80例,随机分为硬膜外阻滞组和蛛网膜下隙阻滞组,每组40例。监测并记录患者麻醉前、硬膜外或蛛网膜下隙给药后各时点SBP、DBP、MAP、HR、SpO2的变化。记录硬膜外或蛛网膜下隙给药后药物起效时间和维持时间,评价两组患者肌松效果,记录两组患者术中牵拉反应、新生儿Apgar氏评分以及麻醉并发症。结果:SB组药物起效时间较EB组显著缩短(P<0.01)。EB组患者给药后10～30min患者MAP有明显下降(P<0.05),而给药后60～180min MAP水平与给药前相比无明显变化(P>0.05);SB组患者给药后3～10min患者MAP较给药前有显著下降(P<0.05),但给药后30～180min患者MAP与给药前相比无明显变化(P>0.05)。SB组肌松效果明显较EB组好(P<0.01),两组新生儿Apgar氏评分比较差异无显著性(P>0.05)。EB组患者术中有牵拉反应,而且术后出现腰背部疼痛;SB组并未出现此类症状。结论:针对剖宫产手术采用布比卡因重比重蛛网膜下隙阻滞是一种有效的麻醉方法。

Objective： To observe the effects of intrathecaf bupivacaine and epidural bupivacaine for anaesthesia on cesarean section patients and fetuses. Methods： 80 pregnant women undergoing elective cesarean section were selected and divided into epidural bupiva- caine group and intrathecal bupivacaine group, with 40 women in each group. The changes of SBP, DBP, MAP, HR and SpO2 before and after anaesthesia were monitored and recorded. The onset time and hold time of analgesia, muscular relaxation effect, tractive reflection, Apgar score and complications of anaesthesia were recorded and compared between two groups. Results： The onset time of analgesia in epidural bupivacaine group was shorter than that in intrathecal bupivacaine group （P 〈 0. 01 ） . In epidural bupivacaine group, the MAP decreased obviously within 10 -30 minutes after anaesthesia （P 〈 0. 05 ）, but there was no difference between 60 - 180 minutes after anaesthesia and before anaesthesia （P 〉 0.05 ） ; in intrathecal bupivacaine group, the MAP decreased obviously within 3 - 10 minutes after anaesthesia （ P 〈 0.05）, but there was no difference between 30 - 180 minutes after anaesthesia and before anaesthesia （P 〉 0.05） . The muscular relaxation effect of intrathecal bupivacaine group was better than that of epidural bupivacaine group （ P 〈 0. 01 ）, but there was no difference in Apgar score between the two groups （ P 〉 0. 05 ） . The complications of anaesthesia in epidural bupivacaine group included tractive reflection and small of the back pain, but no complication occurred in intrathecal bupivacaine group. Conclusion： Intrathecal hyperbaric bupivacaine is an effective anaesthesia for cesarean section.