小剂量布比卡因-芬太尼腰麻行老年阴式全子宫切除术  

Minidose bupivacaine-fentanyl spinal anesthesia for vaginal hysterectomy in the aged

作　　者：王凤君[1] 湛冰[1] 

机构地区：[1]广东省珠海市妇幼保健院,519000

出　　处：《中国妇幼保健》2005年第14期1745-1746,共2页Maternal and Child Health Care of China

摘　　要：目的:腰麻行老年阴式全子宫切除术常发生低血压。鞘内阿片类药物与小剂量的局部麻醉药联合应用是否可获得满意的腰麻效果,而只引起轻微的血压下降。方法:将38例行阴式全子宫切除术的老年病人随机分为A、B两组,每组19例。A组腰麻用药为布比卡因4mg与芬太尼20μg。B组布比卡因10mg。收缩压小于90mmHg或平均动脉压较基础水平下降25%定义为低血压。低血压用麻黄素5～10mg静注,最大剂量50mg,或去氧肾上腺素0.1～0.2mg。结果:A组有2例使用麻黄素10mg。B组有16例使用血管加压药物来维持血压,麻黄素平均使用34mg,有4例使用了去氧肾上腺素。A组收缩压、舒张压、平均动脉压最低时分别下降到(126±24)mmHg、(67±16)mmHg、(86±15)mmHg,而B组为(108±28)mmHg、(59±16)mmHg、(72±19)mmHg,差异有显著性。结论:小剂量布比卡因4mg与20μg芬太尼联合使用行腰麻即可实施老年阴式全子宫切除术。与10mg布比卡因相比小剂量联合用药很少引起低血压,而且几乎不需要血管加压药物来维持血压。Objective:Spinal anesthesia for vaginal hysterectomy in the elderly is associated with a high incidence of hypotension. Whether intrathecal opioids and minidose local anesthetics may achieve reliable spinal anesthesia with minimal hypotension.Methods:Thirty-eight patients undergoing vaginal hysterectomy were randomized into two groups of 19 patients each. Group A received a spinal anesthetic of bupivacaine 4mg plus fentanyl 20μg, and group B received 10mg bupivacaine. Hypotension was defined as a systolic pressure of <90 mmHg or a 25% decrese in mean arterial pressure from baseline. Hypotension was treated with intravenous ephedrine boluses 5～10 mg up to maximum 50 mg, and thereafter by phenylephrine boluses 0.1～0.2 mg.Results:All patients had satisfactory anesthesia. Two of 19 patients in group A required ephedrine, a single dose of 10 mg. 16 of 19 patients in group B required vasopressor support of blood pressure. Group B patients required an average of 34 mg ephedrine,and four patients required phenylephrine. The lowest recorded systolic, diastolic, and mean blood pressure were, respectively, 126±24、67±16、86±15,and 86±13 versus 108±28、59±16、and 72±19 for group A versus group B.Conclusion:A minidose of 4mg bupivacaine in combination with 20 μg fentanyl provides better spinal anesthesia for vaginal hysterectomy in the elderly caused less hypotension than 10 mg bupivacaine nearly without the need for vasopressor support of blood pressure.

关 键 词：血液动力学 腰麻 鞘内阿片 

分 类 号：R713.4[医药卫生—妇产科学]