不同体位对剖宫产腰硬联合麻醉等比重布比卡因阻滞平面的影响

The Effect of Different Positions on Block Plane of Isobaric Bupivacaine for Caesarean Section with Combined SpinalEqidural Analgesia

目的研究不同体位在剖宫产产妇腰硬联合麻醉（CSE）中注入等比重布比卡因的起效时间及麻醉平面。方法择期剖宫产孕妇180例,按麻醉时不同体位随机分为3组进行CSE麻醉。Ⅰ组孕妇水平卧位,Ⅱ组孕妇头低足高5°,Ⅲ组孕妇头低足高10°。分组调整床角度后,于L3~4穿刺,蛛网膜下腔注入0.5%布比卡因2mL后孕妇恢复仰卧位。观察麻醉成功指标：麻醉平面到达T6、运动阻滞（Bromage评分）2分或3分、麻醉效果分级Ⅲ级以上。比较观察各组孕妇入室时、注药后各时间点收缩压（SBP）、舒张压（DBP）、心率（HR）、感觉阻滞、运动阻滞情况以及出现低血压、心动过缓、胸闷等不良反应的情况,3组孕妇10min内（时）麻醉平面达到T6的例数及成功率。结果 3组孕妇感觉阻滞起效时间及运动阻滞起效时间差异无统计学意义（P〉0.05）;Ⅱ组和Ⅲ组10min温度觉及痛觉阻滞平面高于Ⅰ组（P均〈0.05）;Ⅱ组和Ⅲ组的麻醉成功率均高于Ⅰ组（P均〈0.05）,Ⅲ组的成功率与Ⅱ组相当（P〉0.05）。3组孕妇各时间点的血流动力学、低血压、心动过缓、胸闷等不良事件的概率差异无统计学意义（P〉0.05）。结论头低足高5°可更快满足及时手术要求,没有过高麻醉平面现象。

Objective To evaluate the effect of horizontal and trendelenburg left lateral position on the onset time and the spread of intrathecal isobaric bupivacaine for elective cesarean delivery.Methods 180 parturients were enrolled to undergo elective cesarean delivery with combined spinal-epidural anesthesia（CSE）.They were randomly divided into 3groups（n=60）according to the different positions during anesthesia：Group Ⅰ horizontal position,Group Ⅱ trendelenburg position 5°,Group Ⅲ trendelenburg position 10°.A combined spinal-eqidural（CSE）analgesia was performed at the L3-4interspace in either horizontal or trendelenburg left lateral position,according to randomization.2mL of 0.5% isobaric bupivacaine was injected into subarachnoid space when cerebrospinal fluid outflew.Then the patient was placed in a supine position.The success criteria of anesthesia was：T6sensory block,Bromage grade 2or 3（motor block）,anesthesia effect≥gradeⅢ.The systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）,sensory block,motor block and adverse reactions such as hypotension,bradycardia,chest distress were observed after the 3groups parturients entered into operating room.The numbers and success rate of GroupⅠ,ⅡandⅢ which got T6 sensory block in ten minutes were observed.Results Among Group Ⅰ,Ⅱ and Ⅲ,there were no significant differences in onset time of sensory block and motor block（P0.05）.The cold and pinprick sensation level in 10 min of GroupⅡand GroupⅢ were higher than that of GroupⅠ（P0.05）.The success rate of Group Ⅱ orⅢ was higher than Group Ⅰ（P0.05）.The success rate of GroupⅢ was higher than that of Group Ⅱ,but not with significant difference（P0.05）.There were no significant differences in hemodynamics,adverse reactions such as hypotension,bradycardia,chest distress among three groups（P0.05）.Conclusion The trendelenburg 5°position can meet the requirement of operation without high anesthesia level.