布比卡因混合肾上腺素骶管阻滞对全麻新生儿血液动力学的影响  

Hemodynamic effects of caudal block with bupivacaine and adrenaline in the newborn undergoing elective surgery under general anesthesia

作　　者：邓萌[1] 王炫[1] 贺琳[1] 郑珊[2] 

机构地区：[1]复旦大学附属儿科医院麻醉科,上海市201102 [2]复旦大学附属儿科医院外科,上海市201102

出　　处：《中华麻醉学杂志》2008年第10期909-911,共3页Chinese Journal of Anesthesiology

基　　金：复旦大学附属儿科医院新生儿重点实验室青年基金项目

摘　　要：目的评价布比卡因混合肾上腺素骶管阻滞对全麻新生儿血液动力学的影响。方法择期或限期行腹部或会阴部手术的足月新生儿30例，性别不限，ASAⅠ或Ⅱ级，出生体重≥2500g，日龄≤28d，随机分为3组（n=10）：全麻组（A组）、全麻＋骶管阻滞（0．2％布比卡因1．25ml／kg）组（AP组）和全麻＋骶管阻滞（0．2％布比卡因混合1：200000肾上腺素，1．25ml／kg）组（AE组）。分别于骶管阻滞前5min（T1）及骶管阻滞后5、10、15min（T2-4）时采用超声心动图仪监测心率、每搏量、心输出量，记录平均动脉压、收缩压、舒张压，计算全身血管阻力。结果与，T1时比较，A组T4时心率减慢，AP组T2-4时心率减慢，AP组T4时心输出量减少，AE组T4时舒张压降低（P〈0．05或0．01）；各组间血液动力学指标差异均无统计学意义（P〉0．05）。结论单独应用布比卡因或混合肾上腺素行骶管阻滞对全麻新生儿血液动力学无明显影响。Objective To investigate the effects of caudal block with bupivacaine and adrenaline on the hemodynamics in the newborn undergoing general anesthesia for elective surgery. Methods Thirty ASA Ⅰ or Ⅱ full-term neonates aged ≤28 days weighing ≥ 2 500 g undergoing elective abdominal or genitourinary surgery under general anesthesia were studied. Children with known cardiovascular abnormalities, infectious diseases or intestinal obstruction and those with conditions contraindicating caudal block were excluded from the study. The children were randomly allocated into 3 groups （n = 10 each）： group 1 general anesthesia （A）; groupⅡ general anesthesia ＋ caudal block （0.2% bupivacaine 1.25 ml/kg） （AP） and group m general anesthesia ＋ caudal block （0.2% bupivacaine 1.25 ml/kg ＋ adrenaline 1：200 000） （AE）. Anesthesia was induced with propofol 3 mg/kg iv. Tracheal intubation was facilitated with vecuronium 0.15 mg/kg. The patients were mechanically ventilated. PETCO2 was maintained at 30-35 mm Hg. Anesthesia was maintained with 0.4% sevoflurane ＋ 40% N2O ＋ 60 % O2. Radial artery was cannulated for continuous BP monitoring. HR, cardiac output （CO） and stroke volume （SV） were monitored using noninvasive transthoracic echocardiography and recorded at 5 min before, and 5, 10 and 15 min after performance of caudal block. Systemic vascular resistance （SVR） was calculated （SVR = MAP/CO ×80 ）. Results There were no significant differences in the hemodynamic variables between the 3 groups. Conclusion Caudal block with bupivacaine alone or with adrenaline exerts no significant effects on hemodynamics in the newborn undergoing elective surgery under general anesthesia.

关 键 词：布比卡因 肾上腺素 麻醉 脊尾 血液动力学现象 婴儿 新生 

分 类 号：R726.1[医药卫生—儿科]