小剂量布比卡因蛛网膜下腔阻滞联合硬脊膜外腔阻滞用于分娩镇痛的临床观察  

Low-dose spinal bupivacaine combined with spinal and epidural anesthesia in labor analgesia:a clinical observation

作　　者：徐韬[1] 卫宇[1] 安小虎[1] 余大松[1] 

机构地区：[1]中国福利会国际和平妇幼保健院麻醉科,上海200030

出　　处：《上海医学》2010年第12期1100-1102,共3页Shanghai Medical Journal

摘　　要：目的探讨小剂量布比卡因蛛网膜下腔阻滞联合硬脊膜外腔阻滞对分娩镇痛效果的影响。方法 60例单胎头位自然分娩的初产妇,随机分为蛛网膜下腔阻滞-硬脊膜外腔阻滞联合镇痛组(CESA)和硬脊膜外腔阻滞镇痛组(EA组),各30例。CESA组应用0.075%布比卡因1.5 mg蛛网膜下腔注射后硬脊膜外腔置管,试验剂量为1%利多卡因5 mL,观察5 min无全脊髓麻醉现象,接患者自控镇痛(PCA)泵。EA组试验剂量后5、10 min各注射5 mLPCA预充液,接PCA镇痛泵。比较两组产妇5、15、30、60 min宫缩期的视觉模拟(VAS)评分、下肢运动情况、第1产程活跃期时间、不良反应和新生儿Apgar评分等。结果 CESA组的5、15、30 min宫缩期的VAS评分分别为(3.10±2.83)、(2.23±1.52)、(2.23±1.36)分,均显著低于EA组的(9.07±0.74)、(6.33±1.52)、(3.34±0.94)分(P值均<0.01);两组间60 min宫缩期的V.AS评分的差异无统计学意义(P>0.05)。两组间下肢Bromage评分、新生儿Apgar评分、产妇的不良反应发生率的差异均无统计学意义(P值均>0.05)。结论与硬脊膜外腔阻滞镇痛相比,小剂量布比卡因蛛网膜下腔阻滞联合硬脊膜外阻滞用于分娩镇痛具有镇痛起效快,效果确切,下肢运动、产程不受影响的优点,使产妇感到更为舒适。Objective To discuss the effect of spinal low dose bupivacaine combined with spinal and epidural anesthesia for labor analgesia.Methods Sixty healthy nulliparous women,who had singleton fetus, vertex presentation and wanted vaginal delivery,were recruited and equally randomized into CESA group and EA group.In CESA group,0.075%bupivacaine 1.5 mg was injected into the subarachnoid space.PCA was connected 5 min after the test dose of 1%lidocaine（5 mL）.In EA group,the catheter was placed in the epidural space,also 5 min after the test dose of 1%lidocaine（5 mL）,two doses of 5 mL PCA fluid was injected at 5 min and 10 min,and PCA epidural analgesia continued.VAS scores at 5 min,15 min,30 min,and 60 min of uterine contraction,Bromage Scores and time of active phase were all recorded.The adverse reaction of the mothers and Apgar scores of the neonates were also recorded.Results The VAS scores at 5 min,15 min,and 30 min of uterine contraction were significantly lower in CESA group（3.10±2.83,2.23±1.52,and 2.23±1.36, respectively） than those in the EA group（9.07±0.74,6.33±1.52,3.34±0.94,respectively,P 0.01）.No significant differences were found in VAS scores at 60 min between the two groups（P0.05）;and no significant differences were found in Bromage scores,Apgar scores of neonators and the adverse reaction between the two groups（P0.05）.Conclusion Compared with epidural labor analgesia,spinal low dose bupivacaine combined with spinal and epidural anesthesia has the advantage of quick onset and potent effect without affecting the motor function of the low limb and the labor process,making it more friendly for the nulliparous.

关 键 词：布比卡因 蛛网膜下腔阻滞-硬脊膜外腔联合阻滞 分娩镇痛 

分 类 号：R614[医药卫生—麻醉学]