不同剂量布比卡因用于腰硬联合剖宫产麻醉的临床效果  

Anesthetic effect of Different Doses of Bupivacaine in Cesarean Section under Combined Spinal-epidural Anesthesia

作　　者：朱毓玲 刘萍[1] 田正 张富荣[1] 杨麦巧 ZHU Yu-ling;LIU Ping;TIAN Zheng;ZHANG Fu-rong;YANG Mai-qiao(1 Dept. of Anesthesia,Kunming Yan’an Hospital,Kunming Yunnan 650051;First ClinicalCollege of Kunming Medical University,Kunming Yunnan 650500,China)

机构地区：[1]昆明医科大学附属延安医院麻醉科,云南昆明650051 [2]昆明医科大学第一临床学院,云南昆明650500

出　　处：《昆明医科大学学报》2019年第3期73-77,共5页Journal of Kunming Medical University

基　　金：云南省临床重点专科建设项目(2017)

摘　　要：目的探讨3种不同剂量布比卡因用于正常体质量范围产妇腰硬联合剖宫产麻醉的效果。方法将2017年6月至2018年7月昆明医科大学附属延安医院收治的150例剖宫产产妇分为A、B、C 3组(n=50例),常规于L3～4间隙行腰硬联合麻醉,分别于蛛网膜下腔注入0.75%布比卡因10 mg、11.5 mg和12.5 mg,头侧置硬膜外管4 cm后协助产妇取平卧位。蛛网膜下腔注药后每2 min针刺皮肤法测定麻醉感觉阻滞平面,记录HR、Sp O2及BP,密切观察有无不良反应如低血压、心动过缓、心动过速、恶心呕吐、胸闷的发生并及时处理。结果3组产妇的年龄、身高、体重、BMI (kg/m2)值比较无统计学差异(P>0.05),A组手术时间明显长于B和C组(P <0.05),B组和C组麻醉起效时间、镇痛效果及肌松效果均优于A组(P <0.05),C组产妇在胎儿取出后及手术结束时的MBP明显低于A、B 2组,而在注药后5 min的HR明显高于A、B 2组(P <0.05),3组产妇出现低血压、恶心呕吐和使用升压药例数差异无统计学意义(P>0.05),C组产妇硬膜外加药、静脉辅助用药及改全麻例数少于A、B 2组(P <0.05)。结论在药物的浓度、注药速度及穿刺点选择不变的情况下,按照0.75%布比卡因2 m L加脑脊液1 m L的方法配比,11.5 mg布比卡因腰麻用于剖宫产术可能是最合适和安全的剂量,供临床麻醉参考。Objective To investigate the effect of three doses of bupivacaine in caesarean section under combined spinal-epidural anesthesia for parturients with normal body mass. Methods From June 2017 to July2018, 150 parturients undergoing cesarean section in Yan’an Hospital affiliated to Kunming Medical University were divided into group A, B and C(n = 50 cases). Combined spinal-epidural anesthesia was performed in L3-4 space, 0.75% bupivacaine injection 10 mg, 11.5 mg and 12.5 mg were respectively injected into the subarachnoid, and the parturient were assisted to take a horizontal position after placing epidural tube 4 cm on the head side. The anesthesia sensation blocking plane was measured every 2 min. HR, Sp O2 and BP were recorded,and the occurrence of adverse reactions such as hypotension, bradycardia, tachycardia, nausea, vomiting and chest distress was closely observed and handled in time. Results There was no significant difference in age,height, weight and BMI(kg/m^2) between the three groups(P >0.05). The operation time in group A was significantly longer than that in groups B and C(P< 0.05), and the anesthesia onset time, analgesic effect and muscle relaxation effect in groups B and C were better than those in group A(P< 0.05). MBP in group C was significantly lower than that in group A and B after the fetus was taken out and at the end of the operation, while HR in 5 minutes after injection was significantly higher than that in group A and B( P< 0.05). There was no significant difference in hypotension, nausea and vomiting and the use of antihypertensive drugs in the three groups.Conclusion Under the condition that the drug concentration, injection speed and puncture site selection are unchanged, according to the method of 0.75 % bupivacaine 2 m L plus cerebrospinal fluid 1 ml, 11.5 mg(2.3 m L) of bupivacaine for combined spinal-epidural anesthesia for parturients with normal body mass may be the most appropriate and safe dose in clinical anesthesia.

关 键 词：剖宫产 腰硬联合麻醉 体质量指数 

分 类 号：R614.4[医药卫生—麻醉学]