剖宫产术病人硬膜外左旋布比卡因的胎盘转移  

Placental transfer of epidural levobupivacaine for cesarean section

作　　者：陈宏[1] 赵轶[1] 朱春仙[1] 

机构地区：[1]浙江大学医学院附属妇产科医院麻醉科,杭州市310006

出　　处：《中华麻醉学杂志》2008年第8期740-742,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价剖宫产术病人硬膜外左旋布比卡因的胎盘转移情况。方法择期硬膜外麻醉下剖宫产术病人60例。于L1.2或L2.3间隙进行硬膜外穿刺，穿刺成功后注射0．5％左旋布比卡因5ml（含1：20万肾上腺素）试验剂量，5min后无脊麻征象后，追加9～12ml，5min后再追加1次。娩出时抽取脐动脉血样，进行血气分析；于娩出后1、5min行Apgar评分。选择30例病人，娩出时抽取母体静脉血样和脐静脉血样，采用高效液相色谱法测定血浆左旋布比卡因浓度。结果在硬膜外注药结束后10～22min60例胎儿娩出，新生儿Apgar评分均≥7分，脐动脉血pH值均≥7．25。娩出时母体静脉血与脐静脉血血浆左旋布比卡因浓度分别为0．35±0．24、（0．24±0．21）μg／ml，脐静脉血与母体静脉血血浆左旋布比卡因浓度的比值为0．7±0．3。结论剖宫产术病人硬膜外左旋布比卡因可通过胎盘，脐静脉血与母体静脉血左旋布比卡因浓度的比值为0.7。Objective To determine the placental transfer of epidural levobupivacaine for cesarean section. Methods Sixty parturients （ ASA Ⅰ or Ⅱ ） aged 24-35 yr weighing 60-80 kg undergoing elective cesarean section under epidural anesthesia were studied. Epidural anesthesia was performed at L1.2 or L2.3 interspace. The catheter was advanced 3 cm cephalad into the epidural space. A test dose of 0.5% levobupivacaine 5 ml with 1：200 000 epinephrine was injected. If there were no signs of subarachnoid injection in 5 min, 9-12 nd of 0.5% levobupivacaine was administered twice at 5 min interval. Arterial blood samples were taken from the doubleclamped umbilical cord segment at delivery for determination of blood pH. Apgar scores at 1 and 5 min after birth were recorded. Blood samples were taken from maternal and umbilical vein for determination of plasma levobupivacaine concentration by high performance liquid chromatography （HPLC）. Results The pH of the umbilical arterial blood was≥ 7.25. The Apgar scores at 1 and 5 min after birth were ≥7.0. The levobupivacaine concentration of maternal and umbilical venous blood was 0.35 ± 0.24 and （0.24 ± 0.21 ） μg/ml respectively at the time of delivery. The ratio of umbilical and maternal venous blood levobupivacaine concentration was 0.7 ± 0.3. Conclusion Epidural levobupivacaine can cross the placenta during cesarean section. The ratio of umbilical and maternal venous blood levobupivacaine concentration is 0.7.

关 键 词：麻醉 硬膜外 剖宫产术 胎盘 左旋布比卡因 

分 类 号：R614[医药卫生—麻醉学]