不同剂量布比卡因腰硬联合麻醉用于急诊剖宫产术的临床观察

Clinical observation of different doses of bupivacaine combined with spinal anesthesia for emergency cesarean section

目的:探讨布比卡因腰硬联合麻醉在急诊剖宫产手术中应用的最适剂量。方法:选取单胎产妇90例,随机均分为A、B、C三组。药物剂量分别为A组0.5%布比卡因6 mg、B组0.5%布比卡因7.5 mg和C组0.5%布比卡因9 mg。三组产妇均在左侧卧位下用针内针方法于L 2~3间隙行腰麻,并留置硬膜外导管备用。记录麻醉起效时间和阻滞平面、硬膜外追加药物情况、术中血压和心率的变化及麻黄碱和阿托品的使用情况;记录术中产妇恶心呕吐、胸闷、呼吸困难等不良反应;记录手术医生及产妇对麻醉效果的评价及术后下肢肌力完全恢复所需要的时间。结果:所有产妇均成功完成手术,无需改全麻或静脉辅助用药。A组术中硬膜外腔追加药物率最高,B、C组硬膜外腔追加药物率较低(P<0.051);A组、B组恶心呕吐和胸闷的发生率明显低于C组(P<0.05),下肢肌力恢复时间也少于C组(P<0.05)。结论:0.5%布比卡因7.5 mg腰硬联合麻醉用于急诊剖宫产术,可为产妇提供比较满意的临床麻醉效果。

Objective:To investigate the optimal dose of bupivacaine in combined spinal and epidural anesthesia for emergency cesarean section.Methods:Ninety single pregnant women were randomly divided into three groups(A,B,C).The drug doses were 6 mg of 0.5%bupivacaine in group A,7.5 mg of 0.5%bupivacaine in group B and 9 mg of 0.5%bupivacaine in group C.All puerperae in three groups received spinal anesthesia in the L 2-3 space under the left lateral position with the method of internal acupuncture,and the epidural catheter was reserverved for later use.Record onset time and block plane of anesthesia,the epidural drug supplementation,and the change of intraoperative blood pressure,heart rate and ephedrine,atropine usage,and record the maternal adverse reactions,such as nausea and vomiting,chest tightness,dyspnea,record the evaluation of anaesthetic effect by the doctors and puerperae,and the time required for complete postoperative recovery of lower limb muscle strength.Results:All the puerperae were successfully completed surgery without needing to change general anesthesia or use intravenous medication.The rate of epidural supplementation in group A was the highest,the rate of epidural supplementation in group B and C was lower(P<0.01),the incidence of nausea,vomiting and chest tightness in group A and group B was significantly lower than that in group C(P<0.05),the recovery time of lower limb muscle strength was also less than that of group C(P<0.05).Conclusion:The 0.5%bupivacaine 7.5 mg in combined spinal epidural anesthesia for emergency cesarean section can povide more satisfactory clinical anesthesia effect for puerpera.