肥胖患者蛛网膜下腔阻滞麻醉剖宫产无需降低布比卡因剂量  

作　　者：陈娜 周夏匀 朴慧英 邱灿金 杨世忠 肖飞[2] 

机构地区：[1]武警海警总队医院(嘉兴学院附属江南医院),314000 [2]浙江省嘉兴市妇幼保健院(嘉兴学院附属妇女儿童医院),314000

出　　处：《浙江临床医学》2020年第4期577-579,共3页Zhejiang Clinical Medical Journal

摘　　要：目的观察肥胖对蛛网膜下腔阻滞麻醉剖宫产剂量的影响.方法选择择期剖宫产的肥胖产妇(BMI≥35)及体重正常产妇(BMI<35),即肥胖组(O组)及体重正常组(N组),n=50例.所有患者蛛网膜下腔注射10mg布比卡因.观察蛛网膜下腔药物注射后10min及25min的麻醉阻滞平面下降两个节段的时间、术后第一次按压镇痛泵的时间以及术中去甲肾上腺素的用量.结果鞘内注射后10min,O组和N组患者痛觉阻滞平面分别为T6(T3~T7)和T6(T4~T8),两组之间比较无显著性差异,P>0.05;鞘内注药后25min,O组和N组患者痛觉阻滞平面分别为T4(T3~T6)和T5(T3~T6),两组之间比较无显著性差异,P>0.05.O组与N组患者胎儿娩出前去甲肾上腺素的用量分别为6μg(0~18μg)和0μg(0~18μg),两组之间比较无显著性差异,P>0.05;O组与N组患者胎儿娩出后去甲肾上腺素的用量分别为12μg(0~24μg)和6μg(0~18μg),两组之间比较有显著性差异,P<0.05.O组和N组患者痛觉阻滞平面下降两个节段分别为102min(60~145min)和85min(52~110min),两组之间比较有显著性差异,P<0.05;O组与N组患者术后第一次按压镇痛泵的时间分别为175min(128~215min)和138min(92~174min),两组之间比较有显著性差异,P<0.05.结论肥胖患者蛛网膜下腔阻滞剖宫产麻醉无需降低蛛网膜下腔布比卡因的剂量.Obective To observe the effect of body weight on the requirement of intrathecal bupivacaine in patients undergoing cesarean section with spinal anesthesia.Methods Fifty patients with BMI≥35 or BMI<35 were enrolled and allocated into two groups in this study.Each patient received 10mg of intrathecal bupivacaine.The sensory block with loss of pinprick after 10min and 25min of spinal injection were studied.The requirement of norepinephrine during surgery was recorded.And the time of regression of two block segments and the first time of required rescued postoperative analgesia were also studied.Results There was no significant difference in the sensory block level in the 10min and 25niin after spinal injection[10min,T6(T3~T7)vs.T6(T4~T8);25min T4(T3~T6)vs.T5(T3~T6)],P>0.05.The requirement of norepinephrine before infant delivery was similar between the two groups[6μg(0~18μg)vs.0μg(0~18μg),P>0.05],but was significantly higher in obesity group after infant delivery[12μg(0~24μg)vs.6μg(0~18μg),P<0.05].The time of regression of two block segments and the first time of required rescued postoperative analgesia was significantly longer in Group O than in Group N[102min(60~145min)vs.85min(52~110min),P<0.05;175min(128~215min)vs.138min(92~174min),P<0.05].Conclusion Obesity patients do not need to reduce the dose requirement of bupivacaine in cesarean section with spinal anesthesia.

关 键 词：肥胖 剖宫产 布比卡因 蛛网膜下腔阻滞 

分 类 号：R71[医药卫生—妇产科学]