不同剂量布比卡因低位腰麻联合硬膜外麻醉对剖宫产手术产妇心血管系统的影响

Effects of lower lumber interspaces anesthesia with different doses of bupivacaine combined with epidural anesthesia on cardiovascular system of delivery women undergoing cesarean operation

目的观察不同剂量布比卡因低位腰麻联合硬膜外麻醉对剖宫产手术产妇心血管系统的影响。方法 90例拟行剖宫产的足月产妇,ASA I^II级,按随机数字表法分为I、II、Ⅲ组各30例。分别经腰3~4间隙穿刺注入0.5%布比卡因1.2、1.5和2.0 ml腰麻,联合硬膜外分次注射2%利多卡因,直到麻醉平面至T8。观察脊麻后5、10、15 min时收缩压(SBP)、心率(HR);麻醉时间、术中低血压与心动过缓发生率、肌松效果以及新生儿出生后1、5 min的Apgar评分。结果 II组产妇麻醉时间明显短于I组,新生儿出生后1 min Apgar评分明显高于Ⅲ组,麻醉后血流动力学稳定性较I组差而好于Ⅲ组,差异均有统计学意义(P<0.05)。结论 1.5 ml布比卡因低位腰麻联合硬膜外麻醉具有麻醉时间短、血流动力学稳定性好等优点,在临床上更为实用。

Objective To observe the effects of lower lumber interspaces anesthesia with different doses of bupivacaine combined with epidural anesthesia on cardiovascular system of delivery women undergoing cesarean operation. Methods Ninety parturients（ ASA Ⅰ - Ⅱ） undergoing cesarean section were randomly divided into group Ⅰ,Ⅱand Ⅲ,30 cases in each group. Spinal anesthesia was performed at the 3 - 4 of lumber interspaces by injecting 1. 2 ml of 0. 5% bupivacaine in the group Ⅰ,1. 5 ml in the group Ⅱand 2 ml in the group Ⅲ,respectively. Then,2% lidocaine was injected twice for epidural anesthesia until the level of anesthesia reached to the T8 level. The systolic blood pressure（ SBP） and heart rate（ HR） were observed at 5,10 and 15 min after anesthesia.The time of anesthesia,the incidence of hypotension and bradycardia,effectiveness of muscle relaxation as well as Apgar score of newborn at 1 and 5 min after birth were also recorded. Results The time of anesthesia in the group Ⅱ was significantly shorter than that in the group Ⅰ,and the Apgar score of newborn at 1 min in the group Ⅱ was significantly higher than that in the group Ⅲ. The hemodynamic stability after anesthesia in the group Ⅱ was worse than that in the group I,but better than that in the group Ⅲ（ P〈0. 05）.Conclusion The lower lumber interspaces anesthesia with 1. 5 ml of bupivacaine combined with epidural anesthesia have advantages of shorter anesthesia time and good hemodynamic stability. Therefore,it may be more practical in clinical.