不同局麻药硬膜外麻醉下产妇寒战反应发生率的比较  

Comparison of the incidence of shivering induced by different local anesthetics under epidural anesthesia in parturients undergoing cesarean delivery

作　　者：朱海娟[1] 汪胜友[1] 方向东[1] 王丽[1] 

机构地区：[1]合肥市妇幼保健院麻醉科,安徽合肥230001

出　　处：《皖南医学院学报》2016年第3期279-282,共4页Journal of Wannan Medical College

摘　　要：目的：比较氯普鲁卡因、碳酸利多卡因、罗哌卡因三种局麻药硬膜外麻醉下剖宫产术的寒战反应发生率。方法：选择60例ASAⅠ~Ⅱ级的剖宫产产妇,随机分为3组。硬膜外穿刺成功并排除置管误入血管或蛛网膜下腔后,A组给予3%氯普鲁卡因20~25 m L,B组给予1.73%碳酸利多卡因18~22 m L,C组给予0.75%罗哌卡因14~18 m L,以调整平面至T 6~8水平。术中连续监测EKG、NIBP、Sp O2,评估麻醉效果,观察寒战等不良反应及新生儿情况。结果：A组和B组平面达T 8时间、运动阻滞恢复时间均明显短于C组（P〈0.01）;A组和B组20 min改良Bramag运动评分及麻醉效果评分均高于C组（P〈0.01）。A组寒战反应发生率及程度均低于B组和C组（P〈0.01）。3组新生儿Apgar评分无统计学差异。结论：氯普鲁卡因硬膜外麻醉起效快、效能强、寒战反应发生率低,更加适合于剖宫产手术麻醉。Objective： To compare the incidence of shivering during epidural anesthesia by chloroprocaine,lidocaine carbonate and ropivacaine in parturients undergoing cesarean delivery. Methods： Sixty parturients（ ASAⅠorⅡ） undergoing cesarean delivery under continuous epidural anesthesia were randomized into three groups by the table of random numbers（ n = 20 for each）. After identification of the epidural space and a negative aspiration test for blood or cerebrospinal fluid,the sensory block was adjusted to T 6- 8 level in the three group before surgery. Group A received 3% chloroprocaine in dose of 20- 25 m L; group B,1. 73% lidocaine carbonate in dose of 18- 22 m L; and group C,0. 75% ropivacaine in 14- 18 m L. Blood pressure,EKG and heart rate were continuously monitored. The score of anesthetic effect,the wrench degrees of shivering,the onset and recovery time of sensory and motor blockade,side effects and Apgar score of the neonates were recorded. Results： The time of sensory blockade level to T 8 and the recovery time of motor blockade were shorter in group A and B than in group C（ P〈0. 01）,yet the modified Bramag score and total score of anesthetic effect were higher in group A and B compared to group C（ P〈0. 05）. Group A had lower incidence of shivering（ P〈0. 01）,and Apgar score remained no different among the three groups. Conclusion： Epidural block with 3% chloroprocaine has merits of rapid onset,powerful anesthetic and lower chill reaction,and appears superior to lidocaine carbonate and ropivacaine in parturients undergoing cesarean delivery.

关 键 词：硬膜外麻醉 局麻药 寒战反应 剖宫产术 

分 类 号：R614[医药卫生—麻醉学] R719.8[医药卫生—外科学]