椎管内麻醉卵巢手术和新斯的明硬膜外术后镇痛的比较  

Comparison of Intraspinal Anesthesia Transabdominal Ovarian Operation and Neostigmine on Postoperative Epidural Analgesia

作　　者：王丰顺 王艳 陆惠元[3] 

机构地区：[1]青岛龙田金秋妇产医院麻醉科,山东青岛266071 [2]青岛龙田金秋妇产医院妇产科,山东青岛266071 [3]青岛大学医学院第二附属医院(青岛中心医院)麻醉科,山东青岛266000

出　　处：《中国医药指南》2015年第24期9-11,共3页Guide of China Medicine

摘　　要：目的比较腰硬联合与硬膜外经腹卵巢手术麻醉和左旋布比卡因与布比卡因复合新斯的明术后镇痛效果。方法60例卵巢手术患者，年龄16-48岁，体质量47--83kg，ASAⅠ～Ⅱ级，随机分成A、B两组各30例。L2-3硬膜外穿刺成功，A组注入0．75％布比卡因4mL，B组注入1％利多卡因4mL，各加入20ug肾上腺素作为实验量，B组用腰穿针顺硬膜外穿刺针入蛛网膜下腔，注入布比卡因15mg，然后各向头端置入硬膜外导管4cm，A组硬膜外注入局麻混合液初量，A、B组术中酌情注入追加量，维持阻滞平面。观察比较两组局麻药用量、血液动力学变化、感觉、运动阻滞和零良反应以及术后当VAS评分≥3分，硬膜外注入A组：布比卡因15n培或B组：左旋布此卡因15mg各复合新斯的明2μg／kg。术后记录活动时镇痛强度、镇痛时间和不良反应。结果硬膜外预注0．75％布比卡因4mL再置入硬膜外导管注入局麻药有血液动力学变化较轻（P〈0．05）和不良反应轻，两组感觉和运动阻滞皆较完善，肌松满意。术后VAS评分相比无显著差异（P〉0．05）；注药后痛觉比较明显（VAS评分≥3分）时间：A组（711±128）min、B组（743±143）min（P〉0．05）。结论置管前注入0．75％布比卡因4mL硬膜外阻滞卵巢手术的麻醉血液动力学较稳定，不良反应轻，安全有效并能达到腰麻较完善的麻醉效果。两组复合新斯的明有明显镇痛作用而无明显不良反应。Objective Comparison of combined spinal epidural anesthesia（CSEA）and epidural anesthesia in transabdominal ovarian operation and postoperative analgesic effect of levobupivacaine and bupivacaine compound neostigmine. Methods Sixty patients, ASA classⅠ-Ⅱ, aged 16-48 yr, weighed 47-83 kg, undergoing transabdominal ovarian operation, were randomly divided into A（n=30）and B（n=30）groups. The lumber puncture was performed at the L：_3 interspace, 0.75% bupivacaine 4 mL or 1% lidocaine 4 mL plus 20 μg epinephrine in A or B group as a＂test dose ＂was injected prior to epidural insertion, subarachnoid injection of bupivacaine 15 mgin B group, the catheter was inseted upward 4 cm, the patients would receive local anesthetic mixture as the initial volume in A group. The anesthesia was maintained with epidural adminislration. The local anesthetic, blood pressure and heart rate, the spread level of analgesic and motor b.lock, adverse events were observed and compared. While the VAS score was more than 3 cm after operation, the patients were received epidural bupivacalne as A group or levobupivacalne 15 mg as B group plus neost/Emine 2 μg/kg. Results The epidural anesthesia of a prior injection of 0.75% bupivacaine 4 mL had less change of blood pressure and heart rate（P〈0.05）, as better motor block and muscle relaxation as spinal anesthesia＇s and fewer adverse events. Postoperative VAS score： the two groups had no significant difference （P〉0.05）; after the epidural injection pain is obvious （VAS score≥3 cm）： A group（711±128）min, B group （743±143） min（P〉0.05）. Conclusion A prior epidural injection of 0.75% bupivacaine 4 mL has less hemodynamics change and is safe and as effective as spinal anesthesia＇s for the anesthesia in transabdominal ovarian operation. Postoperative epidural neostigmine coadministerad with bupivacalne or levobupivacaine has obvious pain relief without increasing the incidence of adverse effects.

关 键 词：新斯的明 布比卡因 左旋布比卡因 硬膜外镇痛 经腹卵巢手术 

分 类 号：R614[医药卫生—麻醉学] R713.6[医药卫生—外科学]