不同剂量左布比卡因用于剖宫产术麻醉的安全性比较

Comparison of the safety of different doses of bupivacaine combined with epidural anesthesia for delivery women undergoing cesarean operation

目的：探讨不同剂量左布比卡因应用在剖宫产手术麻醉时的最适宜剂量。方法将120例行剖宫产手术的产妇采用数字表法随机分为 A、B、C 三组，每组各40例，其中 A 组蛛网膜下腔给予0．5％左布比卡因1．5 mL（7．5 mg），B 组给予0．5％左布比卡因2．0 mL（10．0 mg），C 组给予0．5％左布比卡因2．5 mL （12．5 mg），记录三组产妇麻醉效果。结果 A 组麻醉后5 min 中心静脉压（79．47±10．65）mmHg，心率（83．94±8．21）次／min，血氧饱和度（98．16±1．17）％；B 组麻醉后5 min 中心静脉压（76．38±10．15）mmHg，心率（84．03±8．19）次／min，血氧饱和度（98．48±1．06）％；C 组麻醉后5 min 中心静脉压（66．28±18．49）mmHg，心率（76．38±5．68）次／min，血氧饱和度（95．03±0．45）％；A 组麻醉后10 min 中心静脉压（83．54±10．03）mmHg，心率（84．03±8．34）次／min，血氧饱和度（98．25±1．19）％；B 组麻醉后10 min 中心静脉压（82．46±10．11）mmHg，心率（83．95±8．24）次／min，血氧饱和度（98．04±1．15）％；C 组麻醉后10 min 中心静脉压（69．06±17．03）mmHg，心率（74．19±5．48）次／min，血氧饱和度（94．85±0．41）％。其中 A 组和 B 组心脏功能指标变化与 C 组间差异均有统计学意义（F ＝5．165、6．487、7．125、6．145、5．378、4．687，均 P ＜0．05）。A 组麻醉优9例，良17例，差14例；B 组麻醉优24例，良13例，差3例；C 组麻醉优28例，良11例，差1例，其中 B 组和 C 组麻醉效果显著优于 A 组（χ2＝4．887，P ＜0．05）。A 组发生低血压1例，心动过缓2例，恶心呕吐2例，呼吸困难0例；B 组发生低血压2例，心动过缓2例，恶心呕吐3例，呼吸困难1例；C 组发生低血压15例，心动过缓11例，恶心呕吐14例，呼吸困难7例，其中 C 组各项不良反应发生率高于 A 组和 B 组（χ2＝4．168、5．122、4．784、4．896，均 P ＜0．05）。结论采用左布比卡因腰硬联合麻醉应用在剖宫产手术中麻醉效果和应用剂量有关，剂量越大麻醉效果越强，但是对循环干扰越大，采用10 mg 剂量的等比重左布比卡因更为适宜，值得在临床上推广应用。

Objective To explore the safety of different doses of bupivacaine combined with epidural anes-thesia for delivery women undergoing cesarean operation.Methods A total of 120 cases of parturient women with cesarean section surgery were randomly divided into A,B,C three groups （40 cases in each group）.A group was subarachnoidly given 0.5% levobupivacaine 1.5mL（7.5mg）,B group was given 0.5% levobupivacaine 2.0mL （10.0mg）,C group was given 0.5% levobupivacaine 2.5mL（12.5mg）.The anesthesia effect in three groups was recorded.Results 5 min after anesthesia,the central venous pressure,heart rate,blood oxygen saturation in A group were （79.47 ±10.65）mmHg,（83.94 ±8.21）times/min,（98.16 ±1.17）%,which in B group were （76.38 ± 10.15）mmHg,（84.03 ±8.19）times/min,（98.48 ±1.06）%,which in C group were （66.28 ±18.49）mmHg, （76.38 ±5.68）times/min,（95.03 ±0.45）%.10 min after anesthesia,the central venous pressure,heart rate,blood oxygen saturation in A group were （83.54 ±10.03）mmHg,（84.03 ±8.34）times/min,（98.25 ±1.19）%,which in B group were （82.46 ±10.11 ）mmHg,（83.95 ±8.24）times/min,（98.04 ±1.15 ）%,which in C group were （69.06 ±17.03）mmHg,（74.19 ±5.48）times/min,（94.85 ±0.41 ）%,the changes of heart function index in A group and B group had statistically significant differences compared with those in C group（F =5.165,6.487,7.125, 6.145,5.378,6.145,all P 〈0.05 ）.In A group,excellent anesthesia in 9 cases,good in 17 cases,and poor in 14 cases;those in B group were 24 cases,13 cases,3 cases;those in C group were 28 cases,11 cases and 1 case.The anesthesia effect of B group and C group was significantly higher than A group（χ2 =4.887,P 〈0.05）.In A group, hypotension occurred in 1 case,bradycardia in 2 cases,2 cases had nausea and vomiting,shortness of breath 0 case.In B group,hypotension occurred in 2 cases,2 cases of bradycardia,nausea and vomiting 3 cases,difficulty in breathing in 1 case.In C group,15 cases of hypotension,bradycardia in 11 cases,14 cases had nausea and vomiting,dyspnea in 7 cases.The incidence rate of adverse reactions of C group was higher than A group and B group（χ2 =4.168,5.122, 4.784,5.122,all P 〈0.05）.Conclusion The anesthesia effects of levobupivacaine combined spinal and epidural anesthesia in cesarean section surgery is related with dosage,the greater the dosage,the anesthesia effect is stronger, but the circulation disturbance,the greater the use the share such as 10mg dose of levobupivacaine is more suitable, worthy of popularization and application in clinic.