蛛网膜下腔麻醉联合硬膜外容量扩充在剖宫产术中的应用效果分析  

Effect of subarachnoid anesthesia combined with epidural volume extension on cesarean section

作　　者：王亚峰[1] 马利[1] 蓝雨雁[2] 朱蔚琳[1] 罗超[3] 包延丽[1] 甘丽霞[1] 

机构地区：[1]广西壮族自治区人民医院麻醉科,南宁530021 [2]广西医科大学第一附属医院麻醉科,南宁530021 [3]首都医科大学附属北京佑安医院麻醉科,100069

出　　处：《中国医药》2017年第3期411-415,共5页China Medicine

摘　　要：目的分析蛛网膜下腔麻醉联合硬膜外容量扩充在剖宫产术中的应用效果。方法选取2015年1—11月广西壮族自治区人民医院诊治的美国麻醉医师协会分级Ⅰ～Ⅱ级择期行剖宫产术的产妇80例。随机抽签平均分为A组（单纯蛛网膜下腔麻醉），B组（蛛网膜下腔麻醉联合硬膜外容量扩充），各40例。A组患者蛛网膜下腔给予0．5％罗哌卡因10mg与芬太尼10μg的混合溶液；B组蛛网膜下腔给予0．5％罗哌卡因7．5mg与芬太尼10μg的混合溶液，5min后硬膜外给予0．9％氯化钠注射液10ml。比较2组手术时间、最高感觉阻滞平面、达最高感觉阻滞平面时间、感觉阻滞平面恢复至T10时间、最低收缩压、术中疼痛视觉模拟量表（VAS）评分、术后首次需要接受疼痛治疗时间、麻黄碱用量、达最大Bromage评分时间、Bromage评分恢复至0时间等指标及不良反应发生情况。结果B组达最大Bromage评分时间及Bromage评分恢复至0的时间明显短于A组，差异有统计学意义[（4．5±1．2）min比（5．7±2．3）min、（121±20）min比（142±30）min]（P〈0．05）。2组余观察指标差异无统计学意义（P〉0．05）。2组低血压、心动过缓、恶心、呕吐、寒战等不良反应差异无统计学意义（P〉0．05）。结论小剂量罗哌卡因单次蛛网膜下腔麻醉联合10ml0．9％氯化钠注射液硬膜外容量扩充行剖宫产术麻醉效果确切，运动阻滞时间更短。Objective To analyze the effect of subarachnoid anesthesia combined with epidural volume extension on cesarean section. Methods Eighty pregnant women scheduled for cesarean section （ American Society of Anesthesiologists grade Ⅰ -Ⅱ ） in the People＇s Hospital of Guangxi Zhuang Autonomous Region from January to November 2015 were randomly divided into group A and group B, with 40 cases in each group. Group A had subarachnoid anesthesia with 0. 5% ropivacaine 10 mg and fentanyl 10 μg; group B had subarachnoid anesthesia with 0.5% ropivacaine 7.5 mg and fentanyl 10 μg, 5 rain later had epidural volume extension with 0. 9% sodium chloride 10 ml. Operation time, the highest sensory block level, time to the highest sensory block level, time of sensory block regressing to T10, the lowest systolic blood pressure, intraoperative score of visual analog scale（ VAS）, postoperative time to pain treatment, dose of ephedrine, time to maximum Bromage score, time of Bromage score recovering to zero and occurrence of adverse reactions were analyzed. Results The time to maxium Bromage score and the time of Bramage score recovering to zero in group B were significantly shorter than those in groupA[（4.5±1.2）minvs （5.7±2.3）min,（121±20）min vs （142±30）mini（P〈0.05）. The other indicators had no significant differences between groups （ P 〉 0. 05 ）. Incidences of hypotension, bradyeardia, nausea, vomiting and shivering had no significant differences between groups （ P 〉 0.05 ）. Conclusion Single shot subarachnoid anesthesia with low dose of ropivaeaine in combination with 10 ml 0.9% sodium chloride epidural volume extension achieves rapid and exact anesthesia for cesarean section and shortens time of motor block.

关 键 词：硬膜外容量扩充 腰硬联合麻醉 罗哌卡因 芬太尼 剖宫产术 

分 类 号：R614.3[医药卫生—麻醉学]