蛛网膜下腔给予不同比重布比卡因腰-硬联合麻醉在剖宫产术中的效果比较

Effect of bupivicaine to subarachnoid at different specific gravity on CSEA for caesarean section

关键词:  比重  布比卡因  CSEA 剖宫产术  阻滞平面  神经功能

Key words:  specific gravity  bupivicaine  combined spinal and epidural anesthesia (CSEA)  caesarean section  nervous function

摘要:

[目的] 观察比较不同比重布比卡因腰-硬联合麻醉临床应用于剖宫产术的效果、并发症和安全性。 [方法] 选择ASA Ⅰ~Ⅱ级择期选取腰麻-硬膜外联合阻滞麻醉（CSEA）的产妇150例，随机分为3组。L组50例产妇为轻比重组，腰麻药为0.75%布比卡因2 mL+无菌注射用水1 mL；I组50例产妇为等比重组，腰麻药为0.75%布比卡因2 mL +生理盐水1 mL；H组50例产妇为重比重组，腰麻药为0.75%布比卡因2 mL +10%葡萄糖1 mL。硬膜外导管向头侧置管3~4 cm，阻滞不完全者由硬膜外导管注入2%利多卡因联合麻醉。比较分析3组患者麻醉效果，术中不良反应及神经系统并发症的差异。 [结果] 3组患者麻醉从麻醉效果来看，起效时间及达到最高阻滞平面的时间，H组均小于其他两组，差异有显著性意义（P<0.05），L组起效时间最长，出现阻滞不完全，需追加2%利多卡因的例数较多，差异有显著性意义（P<0.05）。H组最高平面维持时间大于其他两组，差异有显著性意义（P<0.05），但术中仰卧位综合征及术后神经系统并发症的发生均高于其他两组，差异有显著性意义（P<0.05）。 [结论] 3种不同比重腰麻液中，0.5%等比重布比卡因用于CSEA剖宫产术效果确切，神经系统并发症少，安全可靠。

Abstract:

[Objective] Evaluating the effectiveness and complications by using bupivicaine at different specific gravity on CSEA for caesarean section. [Methods] 150 parturient (ASAⅠ~Ⅱ) were randomly divided into three groups: L group with 0.75% bupivicaine 2 mL and water for injection 1 mL as spinal fluid; I group with 0.75% bupivicaine 2 mL and normal saline 1 mL; H group with 0.75% bupivicaine 2 mL and 10% glucose 1 mL. 2% lidocaine was supplemented via epidural catheter if necessary. [Results] The onset time and the duration of reaching the height level of group H is shorter than the other. (P<0.05). There was more incomplete block in group L (P<0.05). The highest level maintenance time of group H was longer than the other (P<0.05), supine syndrome and negative effect on nervous function were more than the other groups too(P<0.05). [Conclusions] 0.5% isotonic specific gravity bupivicaine for CSEA is effective and safe for caesarean section.