小剂量布比卡因-芬太尼腰麻行全子宫切除术

Low-dose bupivacaine-fentanyl spinal anesthesia for hysterectomy

目的 探讨鞘内阿片类药物与小剂量局部麻醉药联合应用是否可获得满意的腰麻效果。方法 32例行全子宫切除术的病人随机分为A、B两组 ,每组 16例。A组腰麻用药为布比卡因5mg与芬太尼 2 0 μg ;B组布比卡因 10mg。收缩压小于 90mmHg或平均动脉压较基础水平下降 2 5 %定义为低血压。低血压用麻黄碱 5～ 10mg静注 ,最大剂量 5 0mg ,或去氧肾上腺素 10 0～ 2 0 0 μg静滴。结果 所有病人均获得满意的麻醉效果。A组有 1例使用麻黄碱 10mg。B组有 14例使用血管加压药物维持血压 ,麻黄碱平均使用量 35mg ,有 3例使用去氧肾上腺素。A组收缩压、舒张压、平均动脉压最低时分别下降到 (10 6± 2 2 )、(6 7± 16 )、(81± 13)mmHg ,而B组为 (86± 2 3)、(5 8± 14)、(6 8± 16 )mmHg ,差异显著。结论 小剂量布比卡因 5mg与 2 0 μg芬太尼联合使用行腰麻即可实施全子宫切除术。与 10mg布比卡因相比 。

Objective To explore whether intrathecal opioids combined with low-dose local anesthetics may achieve reliable spinal anesthesia.Methods Thirty-two patients undergoing hysterectomy were randomized into two groups with 16 each.Group A received hupivacaine 5mg plus fentanyl 20μg,and group B received 10mg bupivacaine alone.Hypotension was defined as a systolic pressure of less than 90mmHg or a 25% decrease in mean arterial pressure from baseline.Hypotension was treated with intravenous ephedrine boluses 5-10mg up to maximum 50mg,and thereafter by phenylephrine boluses 100-200μg.Results All patients had satisfactory anesthesia.One of 16 patients in group A required ephedrine,a single dose of 10mg.Fourteen patients in group B needed an average of 35mg ephedrine,and three of those phenylephrine.The lowest systolic,diastolic,and mean blood presure were,respectively,(106±22),(67±16),and (81±13)mmHg in group A versus (86±23),(58±14),and (68±16)mmHg in group B.Conclusions A low-dose of 5mg bupivacaine combination with 20μg fentanyl provides better spinal anesthesia for hysterectomy and has less hypotension than 10mg bupivacaine.