血压正常产妇和子痫前期重度产妇腰硬联合阻滞麻醉剖宫产重比重布比卡因ED_(50)的比较

ED_(50) of hyperbaric bupivacaine for cesarean delivery under spinal in normotensive and preeclamptic patients

目的：研究血压正常产妇和子痫前期重度产妇行剖宫产麻醉时重比重布比卡因的ED50。方法分别选择20例血压正常产妇和子痫前期重度产妇，均实施腰硬联合阻滞麻醉，鞘内重比重的布比卡因从10mg开始，采用Dixon序贯法，每次序贯剂量为1mg，每例均联合5μg的舒芬太尼，成功阻滞的标准定义为平面≥T6或患者无痛。结果血压正常产妇和子痫前期重度产妇鞘内重比重布比卡因择期剖宫产ED50相同（5.5mg；95%CI：4.9～6.0mg）。两组患者术中不良反应的发生率差异无统计学意义（均P＞0.05），两组患者胎儿脐动脉pH、BE的差异有统计学意义（P＜0.05）。结论子痫前期重度产妇剖宫产腰麻联合硬膜外重比重布比卡因混合5μg舒芬太尼腰麻的ED50为5.5mg，与正常产妇剂量相似。

Objective This study aimed to determine the ED50 of intrathecal hyperbaric bupivacaine for normotensive and severely pre- eclamptic patients undergoing elective cesarean delivery. Methods Combined spinal epidural anesthesia was administered using a standardized technique on 20 consecutively preeclamptic and normotensive patients. The dose of intrathe-cal hyperbaric bupivacaine was decided by using the up- and- down method with an initial dose of 10mg and dosing change of 1mg. Al patients received 5μg of sufentanyl intrathecal y with bupivacaine. A successful block was defined as one that resulted in a sensory block to T6 level or the patient without any pain. Results ED50 of intrathecal hyperbaric bupivacaine was identical in severely preeclamptic and normotensive parturients undergoing elective cesarean delivery （5.5mg;95%CI, 4.9-6.0mg）. No sig-nificant difference existed in the two groups of patients in the incidence of adverse reactions （P〉0.05）.There was significant dif-ference between two groups of patients with fetal umbilical arterial blood gas （P〈0.05）. Conclusion When a combined- spinal epidural is planned in normotensive or severely preeclamptic patients for an elective cesarean delivery, the ED50 of intrathecal hy-perbaric bupivacaine along with 5μg of sufentanyl is similar between each other.