左旋布比卡因腰-硬联合麻醉在剖宫产术中的应用  

Application of spinal and epidural anesthesia with levobupivacaine in casarean section

作　　者：熊洪书[1] 肖维[1] 

机构地区：[1]重庆市第三人民医院麻醉科,400014

出　　处：《检验医学与临床》2010年第11期1037-1039,共3页Laboratory Medicine and Clinic

摘　　要：目的探讨国产左旋布比卡因(LBUP)腰-硬联合麻醉用于剖宫产手术的可行性和安全性。方法 80例ASAⅠ～Ⅱ级行剖宫产手术的患者随机分为A、B、C、D4组各20例接受腰-硬联合麻醉,4组腰麻用药分别为:0.75%LBUP1mL+10%葡萄糖注射液(GS)0.5mL+3%麻黄碱(Eph)0.5mL、0.75%LBUP1.2mL+10%GS0.5mL+3%Eph0.5mL、0.75%LBUP1.6mL+脑脊液(CSF)1mL、0.75%LBUP2mL+CSF1mL。腰麻效果欠佳者硬膜外用0.75%LBUP、术中连续监测呼吸和循环功能状况。评估麻醉效果和维持时间,并观察围术期不良反应的发生及新生儿状况。结果 (1)4组在腰麻起效时间、达到最高阻滞平面时间和下肢阻滞程度上相似,但在阻滞范围上依次增加,平均分别为T8±1.20、T6±1.18和T4±1.10、T3±1.27,差异有统计学意义。(2)腰麻效果不满意,A、B组分别为67.5%和5.6%,但在硬膜外追加0.75%LBUP后麻醉效果满意;C、D组腰麻效果均为极好,D组低血压发生率、恶心呕吐发生率较高,并有3例呼吸困难。(4)未见全身及神经不良反应。结论剖宫产手术选用0.75%左布比卡因9～12mg腰麻效果理想安全。Objective To investigate the feasibility and safety of levobupivacaine （LBUP）used in spinal and epidural anesthesia for cesarean section.Methods 80 cases of ASA Ⅰ-Ⅱ cesarean section were randomly divided into A,B,C,D groups for spinal and epidural anesthesia medication：0.75% LBUP 1 mL ＋10% glucose（GS） 0.5 mL ＋3% ephedrine（Eph ） 0.5 mL,0.75% LBUP1.2 mL ＋10% GS 0.5 mL ＋3% Eph 0.5 mL,0.75% LBUP 1.6 mL ＋ CSF 1 mL,0.75% LBUP 2 mL ＋ CSF 1 mL.Cases with poor results on spinal and epidural anesthesia used 0.75% LBUP,in the continuous monitoring of respiratory and circulatory function status.To estimate the narcotic effects and maintenance time and observe the occurrence of adverse reactions and neonatal conditions.Results （1）The onset time,timing for the highest block levels and lower extremity block extent were similar,but block scopes were increased,the averages were T8 ± 1.20,T6 ± 1.18,and T4 ± 1.10,T3 ± 1.27,the difference was significant.（2）Spinal anesthesia effects were not satisfied in group A and B （respectively,70.0% and 5.0%）,but additional 0.75% LBUP in the epidural removed the dissatisfaction.For group C and D the narcotic effects were excellent,group D had the higher rate on the incidence of nausea and vomiting,and three cases of breathing difficulties.（4） No systemic adverse reactions and neonatal side effects occurred.Conclusion Cesarean section with of 0.75% levobupivacaine 9 ～ 12 mg for spinal and epidural anesthesia will results in satisfactory security.

关 键 词：左旋布比卡因 腰-硬联合麻醉 剖宫产 

分 类 号：R719.8[医药卫生—妇产科学]