不同浓度布比卡因腰麻对妇科手术麻醉效果的影响

目的比较不同浓度的布比卡因对妇科手术麻醉效果的影响。方法选择在腰硬联合麻醉下行腹式子宫切除患者40例,ASA Ⅰ-Ⅱ,按布比卡因不同浓度随机均分成4组（0.75%、0.56%、0.45%、0.38%布比卡因组）。所有病人行腰段第2、3椎间隙穿刺,并行蛛网膜下腔阻滞。注药后分别于5、10 min行改良bromage评分及针刺法检查双侧疼痛感觉阻滞平面。记录最低血压及出现时间。评价腹肌松弛效果。结果0.38%布比卡因组5、10 min感觉阻滞平面与0.75%布比卡因组比较,差异有显著性（P〈0.05）,最低血压出现时间：0.38%布比卡因组短于0.75%布比卡因组（P〈0.05）。0.38%布比卡因组肌松满意度最差。结论在腰麻中,相同剂量布比卡因随浓度下降麻醉平面扩散快,但运动神经阻滞起效时间长,肌松持续时间短,以浓度为0.5%左右（0.45%～0.56%）布比卡因为最佳。

The Efficacy of Spinal Anesthesia With Different Concentration of Bupivacaine in Abdominal Hysterectomy

Objective To compare the efficacy of spinal anesthesia with different density of bupivacaine in abdominal hysterectomy. Methods Forty ASA grade Ⅰ- Ⅱ patients undergoing elective abdominal hysterectomy were randomized to four groups with ten eases each ： group 0.75%, group 0. 56%, group 0.45%, and group 0.38%. Lumbar puncture was performed at L2 - L3 interveribral space. The total quantity 1.5mL of bupivacaine 0.75% were injected into subarachnoid in group 0.75%. The total quantity 1.5mL of bupivacaine combined with cerebrospinal fluid 0. 5mL, 1. 0mL and 1.5mL respectively were also injected in group 0.56% ,group 0. 45% and group 0.38%. Needling method for sensory block assessment and moditled Bromage scale for motor block were used both 5 rain and 10 min after subarachnoid injection. The lowest blocd pressure and the time when it happened were recorded. Abdominal muscle relaxation were also assessed. Results Compared with group 0. 75%, the sensory block was significantly different both at 5 min and 10 min after subarachnoid injection in group 0.38% （ P 〈 0.05 ）. Abdominal muscle relax was the most unsatisfactory in group 0.38% of the four groups. Conclusion With the decline in concentration of the same dose of local anesthetics the sensory block would spread quickly, but the motor block would effect lately and the lasting of muscle relax would be short in spinal anesthesia. Bupivacaine 0.5% was good for spinal anesthesia in abdominal hysterectomy.