不同剂量布比卡因蛛网膜下腔麻醉用于剖宫产的临床观察

Clinical Observation of Different Doses of Bupivacaine Subarachnoid Anesthesia for Cesarean Section

目的:探讨布比卡因蛛网膜下腔麻醉用于剖宫产的最佳剂量。方法:将2009年8月-2011年8月在我院择期行剖宫产手术患者180例随机均分为3组,分别给予0.75%布比卡因2.0mL(A组)、1.5mL(B组)、1.2mL(C组)进行蛛网膜下腔麻醉,观察麻醉起效时间、痛觉消失时间、痛觉恢复时间、运动阻滞恢复时间、运动阻滞最大程度(Bromage评分),同时记录麻醉前及麻醉后5、10、15、30min时患者的血压、心率、血氧饱和度(SpO2)和新生儿Apgar评分;观察麻醉后低血压、恶心呕吐、产妇术后头痛等不良事件发生情况。结果:麻醉起效时间和痛觉恢复时间3组比较无显著性差异(P>0.05),痛觉消失时间、Bromage评分和运动阻滞恢复时间A、B组与C组比较均有显著性差异(P<0.05)。3组麻醉前及麻醉后5、10、15、30min的心率、SpO2比较无显著性差异(P>0.05);A组血压在麻醉5min时出现降低,与B、C组比较有显著性差异(P<0.05),其他时间3组血压比较无显著性差异(P>0.05)。3组新生儿出生1、5、10min时Apgar评分均>7分,3组比较无显著性差异(P>0.05);A组患者术中出现低血压、恶心发生率较高,与B、C组比较有显著性差异(P<0.05)。术中呕吐和术后头痛3组比较无显著性差异(P>0.05)。结论:应用0.75%布比卡因1.5mL蛛网膜下腔麻醉进行剖宫产效果确切,既能保证麻醉效果,又能最大限度减少不良反应的发生。

OBJECTIVE： To investigate the optimal dose of bupivacaine subarachnoid anesthesia for cesarean section. METHODS： 180 patients undergoing elective cesarean section were randomly divided into 3 groups. They were given 0.75% bupivacaine 2.0 mL （group A of 60 patients）, 1.5 mL （group B of 60 cases）, 1.2 mL （group C of 60 cases）, for spinal anesthesia. The onset time of anesthesia, pain disappearance time, pain recovery time, motor block recovery times, the maximum degree of motor block, 5, 10, 15, 30 min before and after anesthesia, blood pressure, heart rate, oxygen saturation （SpO2）, Apgar score, the occurrence of anesthesia hypotension, nausea, vomiting, headache and other maternal adverse events were all observed. RESULTS： The anesthetic onset time and pain recovery time of 3 groups showed no significant difference （P〈0.05）, and pain disappearance time, Bromage scores and motor block recovery times had significant difference among group A, B and C （P〈0.05）. The heart rate and SpO2 before anesthesia and 5, 10, 15, 30 min after anesthesia had no significant difference among 3 groups （P〈0.05）; blood pressure of group A after 5 min anesthesia decreased, there was significant differences between group B and C （P〈0.05）, blood pressure of 3 groups showed no significant difference at other times （P〈0.05）. Apgar scores of 3 groups were 7 points 1, 5, 10 min after birth, there was no significant difference （P〈0.05）. Intra-operative hypotension and nausea in group A had a high incidence, ther was significantly difference between group A and group B, C （P〈0.05）. Intra-operative vomiting and postoperative headache had no significant difference among 3 groups （P〈0.05）. CONCLUSION： 1.5 mL 0.75% bupivacaine subarachnoid anesthesia for cesarean section is effective, both to ensure the anesthetic effect, but also to minimize side effects.