鞘内布比卡因混合舒芬太尼用于剖宫产手术麻醉

目的探讨剖宫产患者鞘内小剂量布比卡因混合舒芬太尼腰麻的麻醉效果及镇痛效果。方法 ASAⅠ～Ⅱ级,单胎,无妊娠并发症,心肺功能正常的剖宫产患者80例,随机分为A(布比卡因)、B(布比卡因+舒芬太尼)两组,每组40例,所有患者术前不用药,入室后麻醉面罩给氧、监测、开放静脉、以1000ml/h速率输注羟乙基淀粉130/0.4氯化钠溶液(万汶)500ml,同时右侧卧,用腰-硬联合穿刺针于L2～4穿刺,成功后在蛛网膜下腔尾向注入麻醉药,10～15s内注完,头向置入硬膜外腔导管备用。左侧15～30°仰卧,控制痛觉平面在T6～8以下。观察注药前即刻(t0,基础值)、注药后3min(t1)、6min(t2)、15min(t3)、30min(t4)时SBP、DBP、HR、SpO2;感觉阻滞及运动神经阻滞情况;感觉阻滞平面消退时间、感觉平面固定后测双下肢运动神经阻滞情况和完全恢复时间、镇痛时间;注药后48h内寒战、恶心呕吐和瘙痒情况。结果两组患者年龄、身高、体质量、麻醉操作时间和手术时间比较差异无统计学意义(P>0.05)。与t0比较,A组t1～4SBP、DBP降低(P<0.01),B组各指标差异无统计学意义。两组均无呼吸抑制出现,与A组比较,B组运动神经阻滞不全、低血压的发生率低,瘙痒及术后恶心呕吐的发生率高,感觉阻滞平面消退时间及运动神经阻滞完全恢复时间缩短(P<0.05);A、B两组痛觉阻滞不全发生率差异无统计学意义(P>0.05);与A组比较,B组的镇痛时间明显延长(P<0.05)。结论剖宫产患者鞘内7.5mg布比卡因混合10μg舒芬太尼麻醉效果满意,血流动力学平稳,不良反应少并可以起到一定的术后镇痛作用。

Application of intrathecal bubivacaine in combination with sufentanil to Caesareen section

Objective To investigate the anaesthetic effect of subarachnoid block with low dosage bubivacaine in combination with sufentanil on Caesareen section.Methods A total of 80 ASA in-patients with normal cardiopulmonary function and physical status I or II,who had no pregnant complications,were scheduled to undergo Caesareen section.They were randomly allocated to Group A (n=40,receiving bubivacaine alone) and Group B (n=40,receiving bubivacaine and sufentanil) .All the patients took no medication before anaesthesia.After having entered the operating room,every patient received given mask oxygen inhalation,monitoring and intravenous infusion of hydroxyethyl starch (500 ml,at a speed of 1,000 ml/h) .Every patient slept on right side,and received successful spinal-epidural needle puncture at L2-4 and injection of anesthetic toward buttock within 10-15 seconds.An epidural catheter was placed toward head in reserve.They were kept at a supine position of 15-30 degrees on left side and con-trolled pain plane below T6-8.The parameters,such as SBP,DBP,HR and SpO2,were observed at the time of 0-min (t0) before injection of anesthetic,and 3-min (t1) ,6-min (t2) ,15-min (t3) and 30-min (t4) after injection.Results The patients were of no significant differences in age,height,weight,anesthetic procedure time and operation time between the two groups (P > 0.05) .Compared with t0,the parameters of SBP and DBP at t1-4 reduced significantly in Group A (P<0.01) ,but they was not significantly different in Group B.No respiratory depression occurs in the two groups.Compared with Group A,Group B had a decreased incidence of incomplete motor block and low blood pressure,but had an increased incidence of nausea,vomiting and itching.The time of feeling block subsidence and the time of complete motor block plane recovery were lessened in Group B (P<0.05) .There was no significant difference in the incidence of incomplete pain block between the two groups (P>0.05) .Compared with Group A,analgesia after operation was significantly prolonged (P<0.05) in Group B.Conclusion The anaesthetic effect of low dosage of intrathecal bupivacaine (7.5 mg) and sufentanil (10μg) on Caesarean section is satisfactory due to stable hemodynamics,less adverse reaction and sure postoperative analgesia.