不同比例重比重腰麻配合体位调节在剖宫产中的应用

Different Proportion Heavy Proportion of Lumbar Hemp Position Adjustment in the Application of Cesarean Delivery

目的观察不同比例配比的腰麻药在临床剖宫产术中的应用情况,不同的药物比例达到的麻醉效果,和体位调节对麻醉效果的影响,各自的优缺点,以及临床应用中对产妇的血流动力学影响和术中、术后不良反应的发生情况。方法选取我院100例择期剖宫产产妇,年龄20~40岁,身高1.5~1.7 m,ASA分级I或II级,无任何器质性脏器疾病,孕期无任何并发症;将其随机分为两组,A组作为改良配药组(0.75%布比卡因1.5 ml+10%葡萄糖溶液1.5 ml,总量3 ml)注药时,产妇采取水平体位,部分身高超过170 cm的产妇采取-5°头低位,B组作为常规配药组(0.75%布比卡因2.0 ml+10%葡萄糖溶液1.0 ml,总量3 ml)注药时,产妇采取头高足低位,5°角,每组各50例患者。术前认真评估,观察麻醉起效时间、麻醉平面,记录术中血流动力学变化、麻醉效果、肌松效果、牵拉反应、术后不良反应,评估麻醉质量,分析两组之间的相同点和差异,并进行比较。结果 A组产妇术中血流动力学波动低于B组,A组术中及术后不良反应发生低于B组,差异均具有统计学意义(P<0.05)。结论改良配药组选用不同比例腰麻药应用于剖宫产,与常规组麻醉效果相同,但具有更少的血流动力学波动,术中恶心呕吐,呼吸抑制更少,术后肢体麻木发生率更低。

Objective To observe the ratio of different proportion of lumbar anesthesia in the clinical application of cesarean section, the proportion of different drugs reach the effect of anesthesia, and position adjustment for the effects of the anesthesia of their respective advantages and disadvantages, and clinical application of hemodynamic effects and maternal intraoperative, postoperative adverse reactions occur. Methods 100 cases of elective cesarean section in our hospital were selected, the age was 20~40 years old, the height was 1.5 ~ 1.7 m, the ASA grade was I or II, there was no organic organ disease, and there was no complication during pregnancy. They were randomly divided into two groups. A group improved the dispensing group（0.75% bupivacaine 1.5 ml, 10% glucose solution 1.5 ml, a total of 3 ml）. When taking the medicine, the puerpera took the horizontal position, and some women whose height was over 170 cm took the-5° head low position. B group of conventional dosage（0.75% bupivacaine 2.0 ml, 10% glucose solution 1.0 ml, a total of 3.0 ml） injection, maternal head take students low 5°, 50 patients in each group. Careful evaluation before operation, observe the onset time of anesthesia, anesthetic level, record intraoperative hemodynamic changes, anesthetic effect, muscle relaxation effect, traction reaction, postoperative adverse reactions, evaluate the quality of anesthesia, analyze the similarities and differences between the two groups, and compare them. Results The hemodynamic fluctuation in group A was lower than that in group B, and the adverse reactions in group A were lower than that in group B, and the difference was statistically significant（P 〈 0.05）. Conclusion The improved dispensing group used different proportion of waist and anaesthesia for cesarean section, the same effect as the conventional group, but with less hemodynamic fluctuation, less nausea and vomiting, less respiratory depression and lower incidence of limb numbness after operation.