剖宫产术硬膜外容量扩张下鞘内注射等比重布比卡因ED_(50)的测定  

ED_(50) of Intrathecal Isobaric Bupivacaine with Epidural Volume Extension for Cesarean Delivery

作　　者：熊娅琴[1] 倪娟[1] 吴兰[1] 曾葵[1] 马玉姗[1] 

机构地区：[1]四川大学华西第二医院麻醉科,成都610041

出　　处：《四川大学学报（医学版）》2015年第6期953-956,共4页Journal of Sichuan University(Medical Sciences)

摘　　要：目的测定剖宫产术硬膜外容量扩张下鞘内注射等比重布比卡因的半数有效量（ED50）。方法 84例择期剖宫产术孕妇行腰硬联合麻醉,根据随机分组情况鞘内注入等比重布比卡因6、7、8、9、10、11或12mg（n=12）,在硬膜外腔置入导管之后以0.5mL/s的速度注入生理盐水10mL。注入生理盐水后15min内双侧痛觉消失平面到达T6,且感觉阻滞Hollmen分级至少2级被认定为诱导成功。诱导成功并且手术当中硬膜外腔没有追加任何局部麻醉药物被认定为手术成功。采用logistic回归分析测量布比卡因的ED50值。结果诱导成功的ED50值为8.121mg（95%可信区间：7.421~8.821）,手术成功的ED50值为9.012mg（95%可信区间：7.747~10.280）。随着鞘内注射布比卡因的量增加,麻醉平面上升到T6节段所需的时间缩短（P〈0.05）,各组诱导和手术成功的例数增加。各组术中最低血压、去氧肾上腺素的用量以及恶心呕吐的发生差异没有统计学意义。结论剖宫产术硬膜外容量扩张下鞘内注射等比重布比卡因诱导成功的ED50值为8.121mg,手术成功的ED50值为9.012mg。Objective To determine the 50% effective dose（ED50）of intrathecal isobaric bupivacaine in combined spinal-epidural anaesthesia with epidural volume extension for caesarean surgery.Methods Eighty-four women undergoing elective caesarean sections were randomly assigned to seven groups,receiving intrathecally isobaric bupivacaine in a dosage of 6,7,8,9,10,11 or 12mg（n=12per group）,respectively.Ten mL normal saline was injected through an epidural catheter at a rate of 0.5mL/s.Successful induction was defined as Hollmen pinprick block grade 2at a height equal to or higher than T6.Success（surgery）was defined as success（induction）plus no requirement for epidural supplementation throughout surgery.The ED50 values were determined using a logistic regression model.Results The ED50 for success（induction）and success（surgery）were 8.121mg（95%confidence interval：7.421-8.821）and 9.012 mg（95% confidence interval：7.747-10.280）,respectively.With increase in amount of intrathecal bupivacaine,time to success（induction）was shortened（P〈0.05）,resulting in increased successful numbers for both induction and surgery.No differences were found in the use of phenylephrine,haemodynamic stability and the occurrence of nausea and vomiting among groups.Conclusion When combined with epidural volume extension,intrathecal bupivacaine has an ED50 of 8.121 mg and 9.012 mg for success（induction）and success（surgery）,respectively,in women undergoing caesarean sections.

关 键 词：剖宫产 硬膜外容量扩张 布比卡因 腰硬联合麻醉 

分 类 号：R614[医药卫生—麻醉学]