布比卡因用于剖宫产手术麻醉的最佳浓度研究

The study of the optimal concentration of bupivacaine for caesarean section anesthesia

目的通过对不同浓度布比卡因用于产科腰—硬联合麻醉时的安全性和有效性进行研究,探讨布比卡因用于剖宫产手术麻醉的最佳浓度。方法 120例择期剖宫产手术患者,年龄20~40岁,美国麻醉师协会(ASA)麻醉手术危险性分级Ⅰ~Ⅱ级,随机分为对照组即C组(0.5%布比卡因2 ml)、B0.4组(0.4%布比卡因2.5 ml)、B0.3组(0.3%布比卡因3.3 ml),每组40例。采用腰—硬联合阻滞麻醉,记录麻醉注药后麻醉平面达到T6的比例、低血压的发生率、麻黄碱的用量以及麻醉后下肢运动功能的恢复时间,并对肌肉松弛和下肢不适感程度进行评分。结果 3组麻醉平面达到T6的比例分别为87.5%,77.5%和70.0%,对照组与其他2组相比差异无统计学意义(P>0.05)。低血压的发生率与布比卡因浓度呈正相关,对照组低血压的发生率与其他2组相比差异有统计学意义(P<0.05),B0.4组与B0.3组之间差异无统计学意义(P>0.05);麻黄碱的用量在对照组最多,B0.3组与其他2组比较差异有统计学意义(P<0.01);B0.3组与其他2组比较下肢运动功能恢复时间差异有统计学意义(P<0.05)。患者布比卡因浓度越高,肌肉松弛评分越低,3组间差异有统计学意义(P<0.01);下肢不适评分与布比卡因浓度呈负相关,3组间差异有统计学意义(P<0.01)。结论 0.3%布比卡因用于蛛网膜下腔可提供足够的麻醉平面、良好的肌松效果和更少的麻醉不良反应,可安全、有效地用于剖宫产手术的麻醉。

Objective To observe the safety and effectiveness of different concentration of bupivacaine for obstetric spinal anesthesia,and investigate the optimal concentration of bupivacaine. Methods A total of 120 patients,aged between20 to 40 years old,American Society of Anesthesiologists(ASA） Anesthetic Surgical Risk Classification Ⅰ-Ⅱ,undergoing elective cesarean section under general anesthesia,were randomly divided into 3 groups-the control group C(0. 5% bupivacaine 2 ml）,group B0. 4(0. 4% bupivacaine 2. 5 ml） and group B0. 3(0. 3% bupivacaine 3. 3 ml） with 40 cases in each group. The combined spinal-epidural anesthesia were used to record the proportion of anesthetic planes reaching T6 after anesthesia injection,the incidence of hypotension the amount of ephedrine used,and the recovery time of the lower extremity motor function after anesthesia,and the degree of muscle relaxation and lower limb discomfort Score. Using lumbar-spin combined block anesthesia,the ratio of anesthesia level reaching at T6 after anesthesia injection,the incidence of hypotension,the amount of ephedrine used,and the recovery time of the lower extremity motor function after anesthesia were recorded,and the scores of muscle relaxation and discomfort in the lower limbs were scored. Results The proportions of anesthetic planes reaching T6 in the three groups were 87. 5%,77. 5%,and 70. 0%,respectively. There was no significant difference between the control group and the other two groups(P〉0. 05）. The incidence of hypotension was positively correlated with the bupivacaine concentration. The incidence of hypotension in the control group was statistically significant compared with the other two groups(P〈0. 05）. There was no significant difference between B0. 4 group and B0. 3 group(P〉0. 05）. The amount of ephedrine was the highest in the control group,and the difference between the B0. 3 group and the other two groups was statistically significant(P〈0. 01）. The difference in recovery time of lower extremity motor function between the B0. 3 group and the other 2 groups was statistically significant(P〈0. 05）. The higher the bupivacaine concentration was,the lower the muscle relaxation score was,and the difference between the three groups was statistically significant(P〈0. 01）. The lower limb discomfort score was negatively correlated with bupivacaine concentration,and the difference between the three groups was statistically significant(P〈0. 01）. Conclusion 0. 3% of bupivacaine used in the subarachnoid space can provide enough anesthesia level,good muscle relaxation effect and less anesthetic adverse reactions. It can be safely and effectively used for cesarean section anesthesia.