混合舒芬太尼时布比卡因用于剖宫产术重度子痫前期患者蛛网膜下腔阻滞的量效关系

Dose-response relationship of bupivacaine coadministered with sufentanil for subarachnoid block in severely preeclamptic patients undergoing cesarean delivery

目的确定混合舒芬太尼时布比卡因用于剖宫产术重度子痫前期患者蛛网膜下腔阻滞的量效关系。 方法选择行剖宫产术的重度子痫前期患者200例，ASA分级Ⅰ-Ⅲ级，采用随机数字表法分为4组（n＝50）：布比卡因4 mg组（B4组）、布比卡因6 mg组（B6组）、布比卡因8 mg组（B8组）及布比卡因10 mg组（B10组）。4组分别蛛网膜下腔注射布比卡因4、6、8及10 mg，均混合舒芬太尼2.5 μg，用生理盐水稀释至2.5 ml。麻醉有效定义为蛛网膜下腔注药后10 min时，针刺法评估双侧感觉阻滞平面达T6，且无需硬膜外追加利多卡因。采用Probit概率单位法计算混合舒芬太尼时布比卡因用于剖宫产术重度子痫前期患者蛛网膜下腔阻滞的半数有效剂量（ED50）和95%有效剂量（ED95）及其95%可信区间（CI）。 结果混合舒芬太尼时布比卡因用于剖宫产术重度子痫前期患者蛛网膜下腔阻滞的ED50（95%CI）及ED95（95%CI）分别为5.67（5.20～6.10） mg和8.82（8.14～9.87） mg。 结论混合舒芬太尼2.5 μg时布比卡因用于剖宫产术重度子痫前期患者蛛网膜下腔阻滞的ED50及ED95分别为5.67和8.82 mg。

ObjectiveTo determine the dose-response relationship of bupivacaine coadministered with sufentanil for subarachnoid block in severely preeclamptic patients undergoing cesarean delivery.MethodsTwo hundred patients with severe preeclampsia, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective cesarean delivery, were divided into 4 groups（n=50 each）using a random number table： bupivacaine 4 mg group（group B4）, bupivacaine 6 mg group（group B6）, bupivacaine 8 mg group（group B8）, and bupivacaine 10 mg group（group B10）. In B4, B6, B8 and B10 groups, bupivacaine 4, 6, 8 and 10 mg plus 2.5 μg sufentanil in 2.5 ml of normal saline were injected into the subarachnoid space, respectively.Effective anesthesia was defined as bilateral sensory block of T6 achieved at 10 min after intrathecal administration when measured by pin-prick test, and with no need for epidural supplementation（lidocaine）. A probit analysis was used to estimate the 50% effective dose（ED50）and 95% effective dose（ED95）with 95% confidence intervals for bupivacaine, coadministered with sufentanil, when used for subarachnoid block in severely preeclamptic patients underwent cesarean delivery.ResultsWhen coadministered with sufentanil, the ED50 and ED95（95% confidence interval）of bupivacaine were 5.67（5.20-6.10）mg and 8.82（8.14-9.87）mg, respectively, for subarachnoid block in severely preeclamptic patients underwent cesarean delivery.ConclusionThe ED50 and ED95 of bupivacaine for subarachnoid block, when coadministered with sufentanil 2.5 μg, are 5.67 and 8.82 mg, respectively, in severely preeclamptic patients undergoing cesarean delivery.