蛛网膜下腔小剂量布比卡因用于剖宫产手术的理想注药时长探讨

Discussion of the ideal subarachnoid low-dose bupivacaine injection time length in spinal anesthesia for cesarean section

目的:探讨经L_2~L_3间隙0.5%布比卡因7.5 mg蛛网膜下腔注射用于剖宫产手术中理想的注药时长。方法:ASAⅠ-Ⅱ级产妇150例,年龄18~45岁,按蛛网膜下腔注药时长随机平均分为3组:A组20~25 s,B组26~35 s,C组36~45 s。于L_2~L_3间隙穿刺,蛛网膜下腔0.5%布比卡因1.5 m L,硬膜外腔置管作为腰麻效果不佳时的补救措施。主要观察指标为平均动脉压(MAP)、麻醉平面、麻醉后不良反应(恶心、呕吐)、切皮反应、术中牵拉反应、升压药使用情况、新生儿Apgar评分等指标。结果:蛛网膜下腔给药后5 min、10 min、15 min,A组MAP均较B、C组低(P<0.05)。B、C组各时点MAP均无差异(P>0.05)。给药后5 min、10 min、15 min,A组麻醉平面较B、C组高(P<0.05)。在10 min和15 min时B组平面较C组高(P<0.05)。A组恶心呕吐发生率明显高于B、C组(P<0.05)。A组麻黄碱使用率(16%),明显高于B、C组(2%,2%)(P<0.05)。C组切皮时的疼痛反应与A组、B组无差异(P>0.05),术中对腹直肌鞘、腹膜牵拉反应者均多于A组、B组(P<0.05)。3组新生儿Apgar评分比较无差异(P>0.05)。结论:0.5%布比卡因1.5 m L蛛网膜下腔注射用于剖宫产手术,较为理想的注药时长为26~35 s。

Objective：To discuss the ideal time length of subarachnoid 0.5% bupivacaine 7.5 mg for cesarean section through L2-L3 interval puncture. Methods： 150 pregnancy women,aged 18 - 45 year, of ASA Ⅰ- Ⅱ, undergoing cesarean section, according to the subarachnoid injection time length, were randomly divided into three groups, group A （20 - 25 s） , group B （26 - 35 s） , group C （36 -45 s）. In L2-L3 interval puncture ,0.5 % bupivacaine 1.5 mL was injected into subarachuoid space, epidural cavity as a remedial measures for spinal anesthesia. The mean arterial pressure （MAP） ,anesthesia level,adverse reactions （nausea, vomiting） , the reaction to skin incision,intraoperative traction reaction,vasopressor usage, and neonatal Apgar score were recorded. Results：After being injected bupivacaine 5 min, 10 min, 15 min, MAP of group A was lower than the other two groups （P 〈 0.05 ） ,between group B and group C, there were no differences （P 〉0.05）. The anesthesia level of group A at 5 min,10 min and 15 min were higher than the other two groups（ P 〈0.05 ）. At 10min and 15 min,the anesthesia levels of group B were higher than group C（ P 〈 0.05 ）. The incidence of nausea and vomiting in group A was significantly higher than that in group B and group C （ P 〈 0.05 ）. The rate of ephedrine used in group A （ 16% ） was significantly higher than that of B and C groups （ 2% ,2% ） （ P 〈 0.05 ）. In group C, the pain reaction was no difference between group A and group B when skin incision （ P 〉 0.05） , during the operation, the patients with abdominal rectus sheath and peritoneal traction were more than group A and group B （P 〈 0.05 ）. There was no difference among the three groups in neonatal Apgar score （ P 〉 0.05 ）. Conclusions ：To intrathecal 0.5% bupivacaine 1.5 mL for cesarean delivery, the ideal subarachnoid injection time length was 26 - 35 s.