不同比重布比卡因对急诊剖宫产术患者肌肉松弛及血流动力学的影响

Effect of bupivacaine with different specific gravity on muscle relaxation and hemodynamics in patients undergoing emergency cesarean section

目的探讨急诊剖宫产术患者应用不同比重布比卡因的效果。方法选取2021年8月至2022年8月湘潭市妇女儿童医院收治的150例急诊剖宫产术产妇作为研究对象,按照随机数字表法分为A组与B组,每组75例。A组给予等比重布比卡因腰硬联合麻醉,B组给予重比重布比卡因腰硬联合麻醉,比较两组肌肉松弛效果、肌肉松弛效果满意度、不同时间点血流动力学指标、麻醉效果及感觉、运动阻滞起效与恢复时间和术后不同时间疼痛程度、麻醉满意度、并发症发生情况。结果A组肌肉松弛优良率为100.00%,高于B组的90.67%(P<0.05)。A组肌肉松弛效果满意度为100.00%,高于B组的90.67%(P<0.05)。A组麻醉后30 min(T4)心率(HR)慢于B组,麻醉后5 min(T1)收缩压(SBP)、舒张压(DBP)均高于B组(P<0.05),两组间其他时间点HR、SBP、DBP比较差异均无统计学意义。两组麻醉有效率比较差异无统计学意义。A组感觉阻滞恢复时间、运动阻滞恢复时间均短于B组(P<0.05);两组感觉阻滞起效时间、运动阻滞起效时间比较差异无统计学意义。术后即刻、术后6h,两组数字等级评分法(NRS)评分比较差异无统计学意义;术后12、24h,A组NRS评分均低于B组(P<0.05)。A组麻醉总满意度为98.67%,高于B组的89.33%(P<0.05)。A组并发症发生率为4.00%,低于B组的13.33%(P<0.05)。结论等比重布比卡因腰硬联合麻醉能取得更好的肌肉松弛效果,可有效维持产妇血流动力学稳定,缓解产妇疼痛程度,提高麻醉满意度,降低并发症发生率。

Objective To explore the efficacy of bupivacaine with different specific gravity in emergency cesarean section patients.Methods 150 parturients with emergency cesarean section mothers admitted to Xiangtan Women and Children's Hospital from August 2021 to August 2022 were se-lected as the research subjects,they were divided into the group A and the group B according to random number table method,with 75 cases in each group.The group A received equal density bupivacaine combined with spinal epidural anesthesia,while the group B received heavy density bupiva-caine combined with spinal epidural anesthesia.The muscle relaxation effect,satisfaction with muscle relaxation effect,hemodynamic indicators at different times,anesthesia effect and sensation,onset and recovery time of motor block,postoperative pain level at different times,anesthesia satisfac-tion,and incidence of complications were compared between the two groups.Results The excellent rate of muscle relaxation in the group A was 100.00%,which was higher than 90.67%in the group B(P<0.05).The satisfaction rate of muscle relaxation effect in the group A was 100.00%,which was higher than 90.67%in the group B(P<0.05).The heart rate(HR)at 30 min after anesthesia(T4)in the group A was slower than that in the group B,and the systolic blood pressure(SBP)and diastolic blood pressure(DBP)at 5 min after anesthesia(T1)were higher than those in the group B(P<0.05);there were no statistically significant differences in HR,SBP,and DBP at other time points between the two groups.There was no statistically significant difference in the anesthesia effective rate between the two groups.The recovery time of sensory blockade and motor blockade in the group A were shorter than those in the group B(P<0.05);there were no statistically significant differences in the onset time of sensory block-ade and motor blockade between the two groups.Immediately after surgery and 6 h after surgery,there were no statistically significant differences in numerical rating scale(NRS)scores between the two groups;at 12 and 24 h after surgery,the NRS scores in the group A were lower than those in the group B(P<0.05).The total satisfaction rate of anesthesia in the group A was 98.67%,which was higher than 89.33%in the group B(P<0.05).The incidence of complications in the group A was 4.00%,which was lower than 13.33%in the group B(P<0.05).Conclusion Equal density bupivacaine combined with spinal epidural anesthesia can achieve better muscle relaxation effects,effectively maintain stable hemodynamics in parturients,relieve the degree of pain,improve anesthesia satisfaction,and reduce the incidence of complications.