重比重腰麻液在急诊剖宫产中的应用技巧  

Application technique of the hyperbaric spinal fluid in the emergency cesarean section

作　　者：李茂兵[1] 漆升 

机构地区：[1]建德市第一人民医院麻醉科,浙江建德311600

出　　处：《全科医学临床与教育》2010年第4期389-390,396,共3页Clinical Education of General Practice

摘　　要：目的探讨在急诊剖宫产麻醉时重比重腰麻液的注射技巧。方法将先后行急诊剖宫产手术80例患者随机分为研究组、对照组,每组40例,均行腰硬联合麻醉。腰麻液为丁卡因重比重液:1%丁卡因1ml+10%葡萄糖液1ml+3%麻黄碱1ml。研究组以操作医生为参照物,以较大压力分别斜向右上方、左上方注射腰麻液1.0ml和1.4ml,注射速度为0.04ml/s;对照组向产妇头端注射腰麻液2.4ml,注射速度为0.02ml/s。观察两组产妇宫缩痛消失时间、下腹部左右两侧麻醉起效时间、取出胎儿前产妇低血压发生情况。结果研究组产妇宫缩痛消失时间为(10.35±1.47)s短于对照组的(73.27±6.82)s,研究组下腹部左右两侧麻醉起效时间为(75.84±8.51)s短于对照组的(176.85±15.28)s,研究组低血压发生人数少于对照组,差异均有统计学意义(t分别=57.04、50.39,χ2=8.58,P均<0.05)。结论在急诊剖宫产行腰硬联合麻醉时,改变重比重腰麻液的注射方向和速度有利于提高麻醉效果。Objective To study the injection technique of the hyperbaric spinal fluid in the emergency caesarean section. Methods Eighty cases were randomly divided into research group and the control group. There were 40 patients in each group, and underwent lumbar epidural anesthesia. Hyperbaric tetracaine solution： 1% tetracaine 1ml ＋10% glucose solution 1ml ＋3% ephedrine 1ml. The reference was the doctor in the research group, the spinal fluid were injected 1.0 ml to right upper and 1.4 ml to left upper with greater pressure. The injection rate was 0.04 ml/s. In the control group 2.4 ml spinal fluid were injected into the puerpera head with the injection rate of 0.02 ml/s. The time of the uterine contraction pain, useful anesthesia in the right and left lower abdomen and the occurrence of puerpera hypotension before the fetus were removed were observed. Results The disappearance time of the uterine contraction pain in the research group （10.35±1.47）s were shorter than that in the control group （73.27±6.82）s; the time of the useful anesthesia in the right and left lower abdomen in the research group （75.84±8.51）s were shorter than that in the control group （176.85±15.28）s; hypotension cases in the research group were less than that in the control group; the differences were statistically significant （t =57.04,50.39;χ2 =8.58,P 0.05）. Conclusions The changes of the direction and speed of the hyperbaric spinal fluid will improve lumbar epidural anesthesia in the emergency cesarean section.

关 键 词：丁卡因 重比重药液 急诊 剖宫产术 麻醉 脊椎 

分 类 号：R614[医药卫生—麻醉学]