等比重局部麻醉药用于剖宫产麻醉的体会

目的探讨利用局部麻醉药比重来减少剖宫产术腰硬联合麻醉(combined spinal-epidural anesthesia,CSEA)后仰卧位低血压发生。方法 120例产妇(ASAⅠ-Ⅱ级)随机均分为I和H两组,I组用等比重液(0.5%布比卡因2.0ml);H组用高比重液(10%葡萄糖液1.0ml+0.75%布比卡因2.0ml,注入2.0ml)。比较麻醉起效时间,感觉阻滞达峰平面时间,感觉阻滞最多节段数,低血压发生的时间和例数,围手术期血流动力学变化,注药后患者反应等。结果两组都能为剖宫产手术提供良好镇痛与完善肌松。两组产妇麻醉起效时间,低血压出现时间相近,H组麻醉平面比I组高(阻滞节段数多),低血压发生比I组多,感觉阻滞达峰平面时间比I组短,两组间比较差异有统计学意义(P<0.05)。结论与高比重液相比,等比重液对麻醉平面影响较小,可减少剖宫产术CSEA后仰卧位低血压。

Effects of isobaric local anesthetic on combined spinal-epidural anesthesia for cesarean section

Objective To investigate the effects of isobaric local anesthetic on supine hypotension syndrome of puerperas undergoing combined spinal-epidural anesthesia(CSEA) for cesarean section.Methods 120 puerperas(ASAⅠ-Ⅱgrade) were randomly classified into two groups(60 patients for each group).Group I were injected 2.0ml isobaric local anesthetic of 0.5% bupivacaine,and group H were injected 2.0ml hyperbaric local anesthetic,composed of 2.0ml 0.75% bupivacaine and 1.0ml 10% glucose.Anesthesia onset time and required time for sensory block to the highest block plane,hypotension time point and parturient number with hypotension,circulation system changes and adverse reactions were recorded.Results The effect of anesthesia was satisfactory in both two groups.Anesthesia onset time and hypotension time point within groups had no significant difference(P>0.05).Compared with group I,the sensory block plane of group H were significantly higher(P<0.05);parturient number with hypotension of group H were significantly more(P<0.05);required time for sensory block to the highest block plane of group H were significantly shorter(P<0.05).Conclusions Compared with group H,the anesthesia block plane of group I was shorter,and the effect of anesthesia was satisfactory,so it can be decreased the incidences of supine hypotension syndrome of puerperas undergoing CSEA for cesarean section.