布比卡因用于云南高原地区肥胖产妇腰硬联合剖宫产麻醉  

Application of Bupivacaine Combined with Spinal Epidural Anesthesia for Obese Women in Yunnan Plateau

作　　者：朱毓玲 刘萍[1] 卜吴明 周维娟 张富荣[1] 刘丽丽[1] ZHU Yu-ling;LIU Ping;BU Wu-ming;ZHOU Wui-juan;ZHANG Fu-rong;LIU Li-li(Department of Anesthesia,Affiliated Yan'an Hospital,Kunming Medical University,Kunming Yunnan650051,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

出　　处：《昆明医科大学学报》2019年第4期86-90,共5页Journal of Kunming Medical University

基　　金：云南省临床重点专科建设基金资助项目(2017)

摘　　要：目的探讨3种不同剂量布比卡因用于肥胖产妇腰硬联合剖宫产麻醉的效果。方法将2017年2月至2018年8月昆明医科大学附属延安医院收治的120例择期剖宫产的肥胖产妇随机分为A、B、C 3组(n=40例),常规于L_(3-4)间隙行腰硬联合麻醉,分别于蛛网膜下腔注入0.75%布比卡因注射液9 mg、10 mg和11 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、SpO_2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/m^2)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组产妇出现低血压、恶心呕吐和使用升压药例数明显高于B组(P <0.05),C组产妇硬膜外加药例数少于B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 mL加脑脊液1 mL的方法配比,10mg (2 mL)布比卡因腰麻用于肥胖产妇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 usage of three doses of bupivacaine in caesarean section combined with spinal-epidural anesthesia for obese parturients. Methods 120 obese parturients undergoing elective cesarean section admitted to Yan'an Hospital from February 2017 to August 2018 were randomly divided into three groups: group A, group B and group C (n = 40). Routine combined spinal-epidural anesthesia was performed between L3-4 in all groups. 9 mg, 10 mg and 11 mg bupivacaine injection(0.75%) was injected into the subarachnoid space rspectively in the three groups. After epidural tube of 4 cm was placed on the head, the patients were assisted for lying position. HR, SPO2 and BP were recorded every 2 minutes after subarachnoid injection. The occurrence of adverse reactions such as hypotension, bradycardia, tachycardia, nausea, vomiting and chest tightness were observed and treated in time. Results There were no significant differences in age, height, weight and BMI (kg/m2) among the three groups (P > 0.05). The operative time of group A was significantly longer than that of group B and C (P < 0.05). The onset time of anesthesia, analgesic effect and muscle relaxation effects of group B and group C were better than those of group A (P < 0.05). The occurrence of hypotension, nausea and vomiting in group C were better than those of group A (P < 0.05). The number of cases of antihypertensive drugs in group C was signif icantly higher than that in group B (P < 0.05), and the number of epidural drugs addtion in group C was less than that in group B (P < 0.05). Conclusion Under the same concentration, injection speed and puncture point, with 2 ml bupivacaine(0.75%)+ 1 ml cerebrospinal fluid, 10 mg (2 mL) bupivacaine spinal anesthesia for obese parturients during cesarean section may be the most appropriate and safe dose.

关 键 词：剖宫产 腰硬联合麻醉 肥胖 体质量指数 

分 类 号：R332[医药卫生—人体生理学]