布比卡因复合芬太尼腰-硬联合麻醉用于剖宫产对血流动力学的影响研究

Impact of Bupivacaine-fentanyl Combined Spinal-epidural Anesthesia to Hemodynamics in Caesarean Section

目的 评价布比卡因复合芬太尼腰-硬联合麻醉用于剖宫产对血流动力学的影响。方法 选择2014年1月至2015年5月期间在我院接受剖宫产手术的62例患者,分为试验组31例,对照组31例。对照组患者蛛网膜下腔注入1.5m L的0.75%布比卡因,注射总量是1.5m L;试验组患者蛛网膜下腔内注入1m L的0.75%布比卡因、0.5m L的芬太尼（25μg）,注射总量1.5m L。观察记录患者血流动力学指标、术后Bromage运动阻滞评分、镇痛效果及恶心、呕吐等术后不良反应。结果 试验组患者的血流动力学较对照组更稳定,患者心率下降程度小且MAP下降程度不明显,只有1例患者需要采用麻黄碱进行处理。对照组患者MAP下降程度较大,共有8例需要麻黄碱进行处理,有5例心率下降显著需使用阿托品处理。术后Bromage运动阻滞评分：试验组多为2~3分,对照组多为3~4分;试验组患者镇痛时间显著长于对照组。两组患者恶心呕吐、皮肤瘙痒等不良反应无差异。结论 布比卡因复合芬太尼腰-硬联合麻醉用于剖宫产对血流动力学的影响很小,镇痛效果好,术后患者能够较早恢复运动,是一种比较理想的剖宫产麻醉用药。

Objective To evaluate the impact of bupivacaine-fentanyl combined spinal-epidural anesthesia to hemody- namics when used in Caesarean section. Methods 62 patients underwent Caesarean section in the hospital between January 2014 and May 2015 were randomly and equally assigned into two groups, 1. 5mL 0. 75% bupivacaine was injected into subarachnoid space in each patient in the control group and the total injection volume was 1.5mL. While each patient in the study group re- ceived a 1 mL 0. 75% bupivacaine and 0. 5mL fentanyl（25μg）injection in the subarachnoid space, and the total injection volume was also 1.5mL for each patient. The hemodynamics indexes, postoperative Bromage motion blockade rating, analgesic effect and adverse effects like nausea and vomit were recorded. Results Patients in the study group had more stable hemodynamics indexes than patients in the control group. Heart rate of patients in the control group only had a mild decrease and their MAP did not de- crease predominantly. Only 1 patient in this group received a support care of ephedrine. While in the control group, there was a dominant decrease of the patients＇ MAP. A total of 8 patients in this group received ephedrine. And 5 patients in the control group had dominantly low heart rate and atropine was administered. As for the postoperative Bromage motion blockade rating,in the study group, the score mainly ranged from 2 to 3, while in the control group, it mainly located in the interval of 3 to 4. And the analgesic time is longer in the study control with statistic significance. The incidence rate of nausea, vomit, skin pruritus and other adverse effects did not show significant difference. Conclusion When used in Caesarean section,the impact of bupivacaine-fentanyl com- bined spinal-epidural anesthesia to hemodynamics was small and the analgesic effect was remarkable. After surgeries, patients re- ceived this kind of anesthesia could take exercises early.