重比重利多卡因和布比卡因腰麻应用于剖宫产的临床体会

Clinical experience with hyperbaric lidocaine and bupivacaine used in cesarean section

目的分析并评价重比重盐酸利多卡因与盐酸布比卡因腰-硬联合麻醉用于剖宫产中的临床效果。方法将我院收治的急诊剖宫产产妇82例随机分成布比卡因组(甲组)与利多卡因组(乙组)各41例,甲组给予2 ml的0.75%布比卡因+0.5 ml的50%葡萄糖混合液1.5 ml,乙组给予1.5 ml的5%利多卡因。比较两组产妇在麻醉后的呼吸、血压、血氧、心率、起效时间以及肌松作用。结果甲组给药后在各时间段的感觉阻滞起效比较慢,产妇的血压及心率未见明显改变,肌松弛度较好,未见牵拉反应。乙组起效速度较快,在给药5 min后产妇的血压与心率显著降低(P<0.05),在不同时间段其最高阻滞平面相对较高。结论重比重布比卡因与重比重利多卡因腰麻用于剖宫产时的效果以及安全性无较大差别,但利多卡因的起效速度更快且阻滞更为完善,两组局麻药物对循环的影响均较小、安全性较高。

Objective To analyze and evaluate hyperbaric lidocaine hydrochloride and bupivacaine hydrochtoride-epidural anesthesia for cesarean section in the clinical effect. Methods 82 cases of hospital emergency cesarean section were randomly divided into the bupivacaine group （ Group A ） and the lidocaine group （ Group B） 41 cases, Group A given 2 ml of 0.75% bupivacaine 0. 5 ml of 50% dextrose mixture 1.5 ml, B given 1.5 ml of 5% lidocaine. Compared two sets of maternal anesthesia breathing, blood pressure, oxy- gen saturation, heart rate, onset time of muscle relaxation. Results Group A after administration in the feeling of each time block was relatively slow onset of maternal blood pressure and heart rate did not change significantly better degree of muscle relaxation, and no traction reaction. B faster onset of maternal blood pressure and heart rate after administration of 5 min significantly decreased （ P 〈 0.05 ） , in different time periods up to block level is relatively high. Conclusion The efficacy and safety of bupivacaine and hyperbaric lidocaine spinal anesthesia for cesarean section no large difference, but the faster speed of onset of lidocaine and block more complete, the two group of local anesthetic cycle are smaller and higher security.