小剂量布比卡因复合芬太尼腰-硬联合麻醉用于急诊剖宫产的临床观察  

Application of low dose bupivacaine combined with fentanyl plus spinal-epidural anesthesia in emergency cesarean section

作　　者：安小虎[1] 徐韬[1] 王苑[1] 杨琦琳[1] 余大松[1] 

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院麻醉科,200030

出　　处：《临床麻醉学杂志》2011年第5期461-463,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨小剂量布比卡因复合芬太尼腰一硬联合麻醉在急诊剖宫产手术中应用的可行性。方法单胎急诊产妇108例，随机均分为布比卡因复合芬太尼组（BF组）和布比卡因组（B组）。药物分别为0．75％布比卡因5mg加芬太尼20μg和0．75％布比卡因7．5mg。两组产妇均在右侧卧位下于L2～3间隙用针内针方法行腰麻，留置硬膜外导管备用。记录麻醉等待时间、最高平面、硬膜外追加药物的情况，术中心率、血压变化和麻黄碱的使用情况，并记录术中恶心呕吐、胸闷、呼吸困难等不良反应；记录手术医师和产妇对麻醉的评价以及术后下肢肌力完全恢复所需时问。结果所有患者成功完成手术，无需改变麻醉方式或静脉辅助用药。BF组硬膜外腔追加药物率、低血压发生率和麻黄碱使用率明显少于B组（p〈O．01）；麻黄碱平均用量明显少于B组（P＜0．05）；恶心呕吐和胸闷的发生率明显低于B组（P〈O．05或P％0．01）；下肢肌力恢复到Bromage0分的时间短于B组（P＜o．05）。结论0．75％布比卡因5mg复合芬太尼20弘g腰硬联合麻醉能为急诊剖宫产提供满意的麻醉。Objective To evaluate the feasibility of low dose bupivaeaine combined with fentanyl plus spinal-epidural anesthesia in emergency cesarean section. Methods One hundred and eight parturients with singleton fetus for emergency cesarean section were divided randomly into two groups, bupivaeaine with fentanyl group（group BF） and bupivacaine group（group B）. Group BF received 0.75% bupivacaine 5 mg and fentanyl 20μg, while group B received 0.75% bupivacaine 7.5 rag. All the parturients received the a pundure at L2～3 intervertebral space with CESA needles at right lateral position, then epidural catheter was reserved. The following were recorded, onset time, highest sensory level, adding epidural drugs, changes of intrwoperative blood pressure and heart rate, the use of ephedrine, complications such as nausea, vomiting, dyspnea and other side effects. The evaluation from surgeons, patients of anesthesia effects and the time for complete recovery of lower limb muscle strength were also recorded. Results All patients successfully completed the operations without changing anesthesia method or using adjuvant intravenous drugs. Compared with those of group B, group BF had fewer cases in adding epidural anesthetics, hypotension and requiring ephedrine （P〈0.01）. The average dose of ephedrine was lower （P〈0.05）, the incidence of nausea and vomiting were low in group BF （P〈0. 05）, and occurrence of dyspnea was also lower in group BF （P〈0.01）. Time for the lower limb muscle strength return to Bromage 0 score was shorter in group BF （P〈0.05）. Conclusion It provides satisfactory anesthesia for emergency cesarean section that using 0. 75 % bupivacaine 5 mg plus fentanyl 20 μg in combined spinal-eDidural anesthesia.

关 键 词：布比卡因 芬太尼 腰硬联合麻醉 急诊剖宫产 

分 类 号：R614[医药卫生—麻醉学]