腰硬联合麻醉用于妊高征剖宫产的观察

Observation of Combined Spinal Epidural Anesthesia Used in Cesarean Delivery of Pregnancy-Induced Hypertension

目的:探讨0.5%布比卡因7.5 mg蛛网膜下腔注射及2%利多卡因3 m L硬膜外注射用于妊娠期高血压综合征(pregnancy-induced hypertension,PIH)产妇剖宫产手术对母体的安全性。方法:60例行择期剖宫产产妇,按血压情况分为2组:正常血压组(N组)及妊高征组(P组),年龄18~45岁。于L2~3间隙穿刺,蛛网膜下腔0.5%布比卡因1.5 m L(脑脊液或生理盐水稀释),硬膜外腔置管后注入2%利多卡因3 m L。主要观察指标为平均动脉压(mean arterial pressure,MAP)、麻醉平面、麻醉后自觉症状(恶心、呕吐)、切皮反应、术中牵拉反应、升压药使用情况等指标。结果:麻醉后5 min、10 min、15 min,2组MAP下降程度比较均无显著性差异(P>0.05);各组麻醉后MAP与基础MAP比较均降低(P<0.05),但后3个时点组内两两比较无显著性差异(P>0.05)。N组发生低血压的比例与P组比较无显著性差异(P>0.05)。麻醉后5 min,P组平面高于N组(P<0.05),但10 min和15 min时2组平面无差异。2组麻醉后恶心、呕吐、胸闷、气紧等表现和麻黄碱使用、切皮时的疼痛反应、术中对腹直肌鞘、腹膜牵拉反应比例无显著性差异(P>0.05)。结论:0.5%布比卡因1.5 m L蛛网膜下腔注射联合2%利多卡因3 m L硬膜外注射用于PIH产妇剖宫产手术,可提供稳定的血流动力学,安全实用。

Objective: To investigate the reliability of 0. 5% subarachnoid bupivacaine of 7. 5 mg combined with 2%epidural lidocaine of 3 m L in cesarean section of pregnancy-induced hypertension( PIH) parturient. Methods: Sixty pregnancy women of 18-45 years receiving selective cesarean section were averagely divided into two groups according to the blood pressure:group N( normal pressure) and group P( PIH). 0. 5% bupivacaine of 7. 5 mg diluted by cerebrospinal fluid or normal saline was injected into subarachnoid space through the interval of L2- 3,and 2% lidocaine of 3 m L was injected into epidural space after epidural catheter placement. The mean arterial pressure( MAP),the sensory block level,postanesthetic subjective symptom,the reaction to skin incision,traction reaction of rectoabdominal fascia and peritoneum,and the use of ephedrine were recorded.Results: 5 min,10 min,15 min after the injection of bupivacaine,there was no significant difference in MAP decrease between the two groups( P > 0. 05); the postanesthetic MAP values of the two groups were lower than the basic MAP( P < 0. 05),although postanesthetic MAP values at the three time points had no significant differences between the two groups( P > 0. 05). The ratio of hypotension in group N was not significantly different from that in group P( P > 0. 05). The level of sensory block of group P at 5min after anesthesia was higher than that of group N( P < 0. 05). But at 10 min and 15 min,the anesthesia levels of the two groups were similar. The rates of nausea,vomit,chest distress,usage of ephedrine,pain reaction to skin incision,traction reaction of rectoabdominal fascia and peritoneum had no significant differences between the two groups( P > 0. 05). Conclusion:Intrathecal injection of 0. 5% bupivacaine of 7. 5 mg combined with epidural injection of 2% lidocaine of 3 m L in cesarean delivery of PIH parturient is safe and practical.