妇产科术中腰-硬联合麻醉布比卡因用量的临床分析

Clinical analysis on dosage of Bupivacaine combined with spinal-epidural anesthesia in gynecological surgery

目的:探讨妇产科手术使用腰-硬联合麻醉中布比卡因的用量。方法:收集2008年10月～2010年10月在我院行腰-硬联合麻醉的妇产科手术患者240例,其中,剖宫产手术患者、附件包块切除患者和子宫全切术患者各80例,再将这3组不同类型的妇产科手术患者分别按照身高分成4个亚组,即150～155 cm组、156～160 cm组、161～165 cm组和166～170 cm组,每个亚组20例。比较不同类型手术不同身高亚组患者在术中使用布比卡因的用量、药物起效时间、生命体征变化情况等,观察是否存在差异。结果:不同类型手术组和不同身高亚组之间布比卡因药物用量存在差异,用量随着身高的增加而增加,差异具有统计学意义(P<0.05)。各组患者在平均动脉压力(MAP)、起效时间、牵拉反应率方面比较,差异无统计学意义(P>0.05)。结论:麻醉师应根据不同手术类型和患者的身高采用不同的麻醉药用量,改善麻醉效果,减轻麻醉风险。

Objective： To study the dosage of Bupivacaine combined with spinal-epidural anesthesia in gynecological surgery.Methods： 240 patients receiving combined spinal-epidural anesthesia in the gynecological surgery from October 2008 to October 2010 in our hospital were collected,including 80 patients of cesarean section,adnexal mass removal and total hysterectomy respectively.Then the three groups of different patients were respectively divided into four groups by height,namely the group of 150-155 cm,156-160 cm,161-165 cm and 166-170 cm,with 20 patients for each subgroup.The differences in dosage of Bupivacaine,drug onset time,vital signs changes and others of the subgroup surgical patients of different types and heights were compared.Results： There were differences between groups of different surgical types and different heights in the dosage of Bupivacaine which increased as the height increases,with statistical significance（P〈0.05）.There were no statistical differences between different groups in mean arterial pressure（MAP）,drug onset time and stretch reaction rate（P〉0.05）.Conclusion： The anesthesiologists should use different dosages for patients of different surgical types and different heights in order to improve the anesthetic effects and reduce the anesthetic risk.