布比卡因等比重液腰-硬联合麻醉用于经皮肾镜钬激光碎石术的观察  

Clinical study on the combined spinal-epidural anesthesia with isobaric bupivacaine in holmium laser lithotripsy by nephroscope

作　　者：王立文[1] 梁华[1] 贺雅琳[1] 马彩军 袁利邦[1] 刘晓华[1] 丁志刚[1] 

机构地区：[1]解放军第五医院,宁夏银川750004

出　　处：《宁夏医学杂志》2007年第9期799-800,共2页Ningxia Medical Journal

摘　　要：目的探讨布比卡因等比重液腰-硬联合麻醉(CSEA)用于经皮肾镜钬激光碎石术的安全性和有效性。方法65例病人,ASAⅠ-Ⅱ级,均采用腰-硬联合阻滞配套针,于L2-4椎间隙穿刺,以0.1-0.2ml/s速率蛛网膜下腔注入0.75%布比卡因1-2.2ml,并头端置入硬膜外导管。观察感觉平面出现时间、阻滞范围、麻醉平面固定时间、术中并发症及不良反应。结果感觉平面出现的时间为1-3分钟,阻滞范围T5-10-S5,麻醉平面固定时间15-20分钟,运动阻滞起效时间为3-7分钟(Bromage评分3分)。腰麻后30分钟血压下降明显(P<0.05),加快输液或给予麻黄碱后回升。SP02无明显变化(P>0.05)。术中2例发生恶心、呕吐,多与血压降低有关,无腰麻后头痛及其它麻醉相关并发症。结论布比卡因等比重液CSEA用于经皮肾镜钬激光碎石术,是一种安全、有效、快捷和经济的麻醉方法。Objective To evaluate the safety and efficacy of isobaric bupivacaine for combined spinal - epidural anesthesia （CSEA） in holmium laser lithotripsy by nephroscope. Methods Sixty- five ASA I - II patients aged 22 -79 yrs, underwent holmium laser lithotripsy by nephroscope. Spinal puncture was performed in the lateral decubitus position using a 25 - gauge Whitacre needle with the orifice directed laterally at the level of L2 -4 interspace. The patients intrathecally received 1 -2.2 ml of 0.75% isobaric bupivacaine, and then the epidural catheter was inserted to the cephalad direction. Observation included onset time of the maximum anesthetic level of sensory block and motor block, during the operation BP, HR, ECG, RR, Sp0z were monitored. Results The onset time of spinal anesthesia was 1 -3 min and the blockade level was maintained at T5-10. BP decreased significantly （ P 〈 0.05 ） after spinal block 30min, and reversed by 15 -30mg of ephedrine. There were no any serious complications of anesthesia during the operation. Conclusion Isobaric solution of bupivacaine is safe and effective for CSEA in the holmium laser lithotripsy by nephroscope.

关 键 词：布比卡因 等比重液 腰-硬联合麻醉 经皮肾镜 碎石术 

分 类 号：R614[医药卫生—麻醉学]