分娩镇痛转剖宫产术中局麻药中毒1例  

A case of local anesthetic poisoning during the transition from labor analgesia to cesarean section

作　　者：刘绪才 万兵 LIU Xucai;WAN Bing(Department of Anesthesiology,Chongqing Jiangjin District Maternal and Child Health Hospital,Chongqing 402260,China)

机构地区：[1]重庆市江津区妇幼保健院麻醉科,重庆402260

出　　处：《妇儿健康导刊》2023年第2期105-107,共3页JOURNAL OF WOMEN AND CHILDREN'S HEALTH GUIDE

摘　　要：本文报道1例由分娩镇痛转剖宫产术中局麻药中毒的病例,患者从开始实施分娩镇痛至转剖宫产入室前,镇痛效果良好,视觉模拟评分法评分0~2分。入室后回抽硬膜外导管内无血液及脑脊液回流,2%盐酸利多卡因3 ml注入硬膜外腔,5 min后患者未诉不适,追加1%盐酸罗哌卡因10 ml,10 min后开始手术。取出胎儿、胎盘后进一步探查时,患者疼痛感明显,麻醉医生再次追加1%盐酸罗哌卡因5 ml,追加药物5 min后,患者出现抽搐、耳鸣。分析原因为硬膜外分娩镇痛期间及转硬膜外麻醉后手术期间,均存在硬膜外导管移位并进入血管的可能,故每次注药前均应常规回抽。This article reported a case of local anesthetic poisoning during the transition from labor analgesia to cesarean section.The patient had a good analgesic effect from the beginning of labor analgesia to the transition to cesarean section before entering the operating room,and the visual analogue scale score was 0-2 points.After entering the room,there was no blood and cerebrospinal fluid reflux in the epidural catheter.3 ml of 2%Lidocaine Hydrochloride was injected into the epidural space.After 5 minutes,the patient did not complain of discomfort.10 ml of 1%Ropivacaine Hydrochloride was added.The operation started 10 minutes later.When the fetus and placenta were taken out for further exploration,the patient felt obvious pain.The anesthesiologist added another 5 ml of 1%Ropivacaine Hydrochloride.Five minutes after adding the drug,the patient had convulsions and tinnitus.The reason is that there is a possibility of the epidural catheter shifting and entering the blood vessels during epidural labor analgesia and during the operation after epidural anesthesia.So routine withdrawal should be performed before each injection.

关 键 词：分娩镇痛 剖宫产 局麻药中毒 

分 类 号：R614[医药卫生—麻醉学]