子宫切除术椎管内两种麻醉方法麻醉效果的比较  

Comparison of two anesthesia methods in intraspinal anesthesia in uterectomy

作　　者：陆惠元[1] 于礼 范晓琳[1] 

机构地区：[1]山东省青岛大学医学院第二附属医院麻醉科,266042 [2]青岛市骨伤医院医务科

出　　处：《中国厂矿医学》2009年第5期527-529,共3页Chinese Medicine of Factory and Mine

摘　　要：目的比较子宫肌瘤行子宫切除术中椎管内两种麻醉方法的效果。方法60例子宫肌瘤患者,随机分成A、B2组,每组30例。2组均用16号穿刺针硬膜外腔侧入穿刺成功后,A组经穿刺针注入0.75%布比卡因4ml+肾上腺素20μg,然后向头端置入硬膜外导管4cm固定,即刻平卧,经导管注入局部麻醉混合液(1.6%利多卡因+0.2%丁卡因+肾上腺素20μg)2～3次作为初量,每次3～6ml,间隔1～2min;B组注入1%利多卡因4ml+肾上腺素20μg,如无脊麻征和入血管征,用25GⅡ型腰穿针顺硬膜外穿刺针进入蛛网膜下腔,见有脑脊液回流,8～10s内注入等比重药液0.5%布比卡因3ml(配制:0.75%布比卡因2ml+0.9%氯化钠溶液至3ml),然后向头端置入硬膜外导管4cm固定,即刻平卧。2组阻滞平面均达T8以上。2组术中均按需追加局麻混合液以维持麻醉阻滞平面。观察和比较2组血压、心率、感觉和运动阻滞情况,肌松效果和不良反应。结果2组感觉和运动阻滞皆较完善,肌松满意;与B组比较,A组血液动力学变化小,不良反应轻。结论置管前先注入0.75%布比卡因硬膜外阻滞用于子宫切除术麻醉效果满意,且较腰-硬联合麻醉的血液动力学稳定,副作用轻,因而更安全。Objective To compare the anesthesia effects of a prior epidural injection of 0.75 % bupivacaine 4 ml to epidural insertion with combined spinal-epidural anesthesia in uterectomy. Methods Sixty patients undergoing uterectomy were randomly divided into group A（ n = 30） and group B （ n = 30 ）. In all patients,lumber puncture was performed at the L2- 3 interspace, and 0. 75 % bupivacaine 4 ml （ group A） or 1% lidocaine 4 ml（ group B） plus epinephrine 20 μg as a ＂test dose＂ were injected prior to epidural insertion. In group B ,subarachnoid injection of bupivacaine 15mg, and then the catheter was inserted upward 4 cm. In group A, after inserting catheter 4 cm upward the patients would receive sequential mixture of 1.6% lidocaine and 0. 2% tetracaine with epinephrine 20 μg as the initial volume. Sensory blockade to the T8 or T6 level was established. In each group, 2 - 5 ml mixture was incrementally administered if necessary during the operation to maitain blockade level epual or higher Ts upward. The blood pressure, heart rate, the spread level of analgesic and motor block, Bromage score, RAM score and adverse events were observed and compared. Results There were better effects of sensory and motor block in two groups, but less changes of blood pressure and heart rate and fewer events in group A. Conclusions Epidural anesthesia of a prior epidural injection of 0. 75% bupivacaine has satisfactory anesthetic effect and less hemodynamic changes, and so it is more safe.

关 键 词：布比卡因 硬膜外麻醉 腰-硬联合麻醉 子宫切除术 

分 类 号：R614.4[医药卫生—麻醉学] R713.42[医药卫生—外科学]