低剂量布比卡因联合芬太尼腰麻在剖宫产术中的应用

Study on the application of spinal anesthesia with low dosage of bupivacaine combined with fentanyl in caesarean section

目的观察低剂量布比卡因联合芬太尼蛛网膜下腔麻醉在剖宫产手术中的应用效果。方法选择80例ASA I级拟在腰麻下行剖宫产手术的初产妇,随机低剂量布比卡因联合芬太尼组(LBF组,n=40)和常规剂量布比卡因重比重组(CB组,n=40)。LBF组在蛛网膜下腔穿刺成功后注入2 ml用生理盐水稀释的布比卡因与芬太尼混合溶液(布比卡因7.5 mg+芬太尼25μg),CB组注入2 ml用生理盐水稀释的布比卡因溶液(布比卡因10 mg)。观察两组产妇在血液动力学稳定性、麻醉效果、麻醉稳定性、不良反应和新生儿状况方面的差异。结果 LBF组的血液动力学比CB组稳定(P<0.05),麻醉效果优于CB组(P<0.05),使用血管活性药物的比率低于CB组(P<0.05),发生恶心呕吐、低血压、心动过缓的几率显著低于CB组(P<0.05)。两组间新生儿的Apgar评分无显著性差异(P>0.05)。结论低剂量布比卡因(7.5 mg)联合芬太尼(25μg)腰麻是一种用于剖宫产手术中的安全、有效的方法。

Objective To observe the efficacy of application of spinal anesthesia with low dosage of bupivacaine combined with fentanyl in caesarean section. Methods Eighty nulliparous women with physical status level 1 according to the classification of American Society of Anesthesiologists（ ASA） were undertaken with caesarean section under spinal anesthesia,and they were randomly allocated in two groups（ LBF group and CB group,each with 40 cases）. They were received spinal anesthesia with bupivacaine 7. 5 mg combined with fentanyl 25 μg in 0. 9% sodium chloride solution 2ml（ group LBF,n = 40） or bupivacaine 10 mg in 0. 9% sodium chloride solution 2 ml（ group CB,n = 40）. The hemodynamics,effect of spinal anesthesia,stability of anesthesia and side effects were observed in patients of these two groups. Results The stability of hemodynamics in patients of group LBF was significantly better than that of patients in group CB（ P〈0. 05）. The effect of spinal anesthesia in patients of group LBF was significantly better than that of patients in group CB（ P〈0. 05）. The requirement of vasoactive agent in patients of group LBF was significantly lower than that of patients in group CB（ P〈0. 05）. The incidence rates of nausea,vomiting,hypotension and bradycardia in patients of group LBF were significantly lower than those of patients in group CB（ P〈0. 05）. Conclusion The application of low dosage of bupivacaine（ 7. 5 mg） combined with fentanyl（ 25 μg） in spinal anesthesia is an effective and safe anesthetic technique in caesarean section.