两种利多卡因及布比卡因用于剖宫产时硬膜外麻醉的比较观察

目的:观察1.73%碳酸利多卡因与2%盐酸利多卡因、0.5%布比卡因用于剖宫产时硬膜外麻醉的临床效果。方法:259例需做剖宫产手术的病人,随机分别接受1.73%碳酸利多卡因(碳利组,n=88),2%盐酸利多卡因(盐利组,n=91)和0.5%布比卡因(布比组,n=80),观察感觉阻滞(针刺法),运动阻滞(改良Bromage评分),术中疼痛(VAS评分),镇痛和腹壁肌松质量,心血管指标及不良反应。结果:碳利组在麻醉显效和痛觉完全消失的时间上明显短于盐利组和布比组(P<0.05);在麻醉作用持续时间上,碳利组和盐利组无明显差异,但明显短于布比组(P<0.05);碳利组术前及术中阻滞平面达T6病例百分比高于盐酸组和布比组(P<0.01￣0.001);平面达T6所需时间也明显短于盐利组和布比组;碳利组首剂后10分钟出现运动阻滞病例的百分比高于布比组和盐利组(P<0.05),而30分钟时无明显差异;术后运动阻滞完全恢复时间碳利组明显短于布比组,与盐利组无显著差异;碳利组的术中疼痛(VAS)评分低于盐利组和布比组(P<0.05￣0.01);镇痛和腹壁肌松质量优于盐利组和布比组(P<0.05￣0.01);观察中无严重不良反应。结论:1.73%碳酸利多卡因用于剖宫产硬膜外麻醉时,其感觉阻滞及镇痛、肌松效果优于2%盐酸利多卡因和0.5%布比卡因,运动阻滞起效快且较完善,同时恢复迅速。

Comparison of the curative effect of carbonate lidocaine hydrochlorate lidocaine and bupivacaine for epidural anesthesia in modified cesarean section

Objective:To compare the clinical effect of carbonate lidocaine,hydrochlorate lidocaine and bupivacaine for epidural anesthesia in modified cesarean section(CS).Methods:259 parturients prepared for CS were included in this randomized double blind study.Parturients in carbonate group(n=88),hydrochlorate group(n=91) and bupivacaine group(n=80) received 1.73% carbonate lidocaine,2% hydrochlorate lidocaine and 0.5% bupivacaine respectively.The sensory change(acupuncture method),motor blochade(modified Bromage score),visual pain score(VAS),relaxation of obdominal muscles,life signs and side effects were observed respectively.Results:The times of anesthesia onset and pain sense disappearance were significantly shorter in carbonate group than in other two groups(P<0.05);the duration of anesthesia in carbonate group was similar to that in hydrochlorate group,but significantly shorter than that in bupivacaine group(P<0.05).The percentage in the parturients experiencing motor block was higher in carbonate group than in other two groups during the first 10 minutes anesthesia(P<0.05),but it was no significantly difference 30 minutes later.The motor function in carbonate group recovered as quick as hydrochlorate group,but quicker than bupivacaine group.Compared with hydrochlorat group and bupivacaine group,VAS in carbonate group was lower and the relaxation of obdominal muscles was more satisfactory.No serious side effects were found. Conclusion:The curative effect of carbonate lidocaine for epidural anesthesia in modified cesarean section in superior to that of the other two kinds of anesthetic in the sensory change,motor blochade,analgesia,muscle relaxation,motor function recovery.