左旋布比卡因复合芬太尼腰硬联合麻醉在剖宫产手术中的效用

Spinal and epidural anesthesia using varied doses of levobupivacaine combined with fentanyl in cesarean section

目的 观察不同剂量等比重左旋布比卡因复合芬太尼腰麻联合硬膜外麻醉（CESA）用于剖宫产手术的效用.方法 择期行单胎剖宫产手术患者60例,予CESA,腰麻液用脑脊液稀释的等比重左旋布比卡因复合芬太尼20μg混合液3ml,根据腰麻液左旋布比卡因不同剂量将患者随机分为A（7.5mg）、B（10mg）、C（12.5mg） 3组,每组20例.记录最高感觉阻滞平面和达最大运动阻滞时的改良Bromage评分,达到最高感觉阻滞平面时间和感觉阻滞持续时间、运动阻滞起效时间和运动阻滞恢复时间,观察术中疼痛程度和牵拉反应发生情况及需追加硬膜外药液情况.记录患者麻醉前后心率、血压变化及术中心动过缓、低血压的发生及麻黄碱和阿托品使用情况,记录瘙痒、恶心、呕吐、术后头痛等不良反应的发生情况及新生儿娩出后1、5min时的Apgar评分.结果 B组最高感觉阻滞平面和C组最高感觉阻滞平面、达最高感觉阻滞平面时间、感觉阻滞恢复时间、达最大运动阻滞时间及运动阻滞完全恢复时间与A组比较差异有统计学意义（P＜0.05）,C组的最高感觉阻滞平面与B组比较差异有统计学意义（P＜0.05）.A、B、C组麻醉后5、10min的MAP值与麻醉前即刻比较差异有统计学意义（P＜0.05）.C组围术期心动过缓、低血压的发生及麻黄碱、阿托品的使用情况与A组比较差异有统计学意义（P＜0.05）.C组发生恶心、呕吐的产妇与A、B组比较差异有统计学意义（P＜0.05）.结论 复合芬太尼20μg时7.5mg的左旋布比卡因腰硬联合麻醉用于剖宫产手术即能提供理想的麻醉效果,增加血流动力学的稳定性,建议复合芬太尼时适当减少左旋布比卡因的使用量.

Objective To evaluate the application of spinal and epidural anesthesia using varied doses of isobaric levobupivacaine combined with fentanyl for caesarean section. Methods Sixty ASA Ⅰ nulliparous women with a singleton full-term pregnancy scheduled for caesarean section under combined spinal and epidural anesthesia （CESA） were randomly allocated to one of 3 groups （n=20 each） . group A received isobaric levobupivacaine 7.5mg, group B 10 mg and group C 12.5mg. All groups also received fentanyl 20 p g and diluted with cerebrospinal fluid to 3ml. The upper level of sensory block and the Bromage score of maximum motor block were recorded. Time of sensory and motor block,time to peak sensory and maximum motor block,duration of analgesia and motor block and quality of spinal anesthesia during operation were recorded. Hemodynamics, side effects and fetal outcome were also recorded. Results The upper level of sensory block in group C was significantly higher than that in group A and B, and that in group B higher was than in group A （P 〈 0.05 ）.Time to peak level of sensory block and maximum motor block in group C was significantly shorter than that in group A（P〈 0.05 ）.Duration of analgesia and motor block in group C was significantly longer than that in group A （P〈 0.05 ）. There was no significant difference in onset time of motor block, Bromage score of maximum motor block, feeling of pain during operation among three groups. The incidence of hypotension and bradyarrhythmia in group C was higher than that of in group A and more patients in group C were received ephedrine. There was higher incidence of nausea and vomiting in group C than that in group A and B. There was no significant difference in the incidence of headache, itch and Apgar scores of the newborn among the three groups. Conclusion 7.5mg levobupivacaine combined with fentanyl 20 μ g in CSEA can produce satisfactory sensory and motor block for caesarean section, and can increase the stability of hemodynamics.