不同比重布比卡因腰硬联合麻醉对剖宫产术后下肢运动功能的影响

Effect of Different Proportion of Bupivacaine for Combined Spinal-Epidural Anesthesia on Lower Extremities Motor Function After Cesarean Section

目的探讨不同比重布比卡因腰硬联合麻醉对剖宫产术后下肢运动功能的影响。方法选择2016年6月至2017年6月收治的择期行剖宫产术的足月单胎初产妇120例,随机分为观察组与对照组,各60例。观察组产妇给予等比重布比卡因行腰麻(0.75%盐酸布比卡因注射液15 mg混合脑脊液1 mL稀释成0.5%等比重布比卡因3.0 mL,注药2 mL)+硬膜外麻醉,对照组产妇给予重比重布比卡因行腰麻[0.75%布比卡因15 mg(2 mL)+50%葡萄糖0.3 mL混合脑脊液0.7 mL稀释成0.5%重比重布比卡因3.0 mL,注药2 mL]+硬膜外麻醉。结果两组产妇麻醉后1 min(T_1),3 min(T_2),5 min(T_3)收缩压、舒张压较麻醉前(T_0)下降明显(P<0.05),心率较麻醉前明显加快(P<0.05);但观察组产妇波动小于对照组产妇(P<0.05);观察组产妇感觉、运动阻滞起效时间较对照组产妇长(P<0.05);观察组产妇运动阻滞恢复时间较对照组产妇短(P<0.05);观察组术毕Bromage评分明显低于对照组(P<0.05);观察组术中及术后不良反应发生率为41.67%,明显低于对照组的80.00%(P<0.05)。结论与重比量布比卡因相比,等比重布比卡因腰硬联合麻醉用于剖宫产手术麻醉效果更可靠,血流动力学更平稳,有利于术后肢体活动,且不良反应较少,值得临床推广。

Objective To study the effect of different proportion of bupivacaine for combined spinal-epidural anesthesia（ CSEA） on lower extremities motor function after cesarean section. Methods Totally 120 primiparas undergoing cesarean section electively at term single births maternal admitted to the hospital from June 2016 to June 2017 were selected and randomly divided into the observation group and the control group,60 cases in each group. The observation group was given isobaric bupivacaine for spinal anesthesia（ 0. 75%Bupivacaine Hydrochloride Injection 15 mg mixed cerebrospinal fluid 1 mL,in order to dilute to 3. 0 mL 0. 5% isobaric bupivacaine,injection of 2 mL） combined with epidural anesthesia,the control group was given hyperbaric bupivacaine（ 0. 75% Bupivacaine Hydrochloride Injection 15 mg（ 2 mL） ＋ 50% glucose 0. 3 mL mixed cerebrospinal fluid 0. 7 mL,in order to dilute into 3. 0 mL 0. 5%hyperbaric bupivacaine,injection of 2 mL） combined with epidural anesthesia. Results 1 min（ T_1）,3 min（ T_2） and 5 min（ T_3） after anesthesia,the systolic blood pressure（ SBP） and diastolic blood pressure（ DBP） of the two groups were significantly lower than those before anesthesia（ T_0）（ P 0. 05）,the heart rate was faster than that before anesthesia（ P 0. 05）,but the change in the observation group was less than that in the control group（ P 0. 05）. The onset time of sensory and motor block in the observation group was significantly longer than that in the control group（ P 0. 05）,the recovery time of motor block in the observation group was shorter than that in the control group（ P 0. 05）,the Bromage score after operation in the observation group was significantly lower than that in the control group（ P 0. 05）. The incidence rate of adverse reactions during the operation and after the operation in the observation group was 41. 67%,which was significantly lower than 80. 00% in the control group（ P 0. 05）. Conclusion Compared with hyperbaric bupivacaine,isobaric bupivacaine for CSEA used in cesarean section has more reliable effect,stable hemodynamic and less adverse reaction,it is beneficial to postoperative limb movement,which is worthy of clinical promotion.