小剂量布比卡因复合芬太尼腰-硬联合麻醉在剖宫产手术中的临床应用

目的探讨小剂量布比卡因复合芬太尼腰麻-硬膜外联合麻醉（腰-硬联合麻醉）在剖宫产手术中的临床应用及其并发症。方法单胎剖宫产手术80例，ASAⅠ-Ⅱ级，年龄19～45岁，按随机数字表法分为A、B两组，每组40例。A组（实验组）采用4．5mg布比卡因复合20斗g芬太尼腰-硬联合麻醉，B组（常规剂量组）采用9nag布比卡因腰-硬联合麻醉，观察2组患者的血流动力学变化，最高阻滞平面，新生儿出生后1、5minApgar评分，肌力恢复时间及不良反应。结果术中A组低血压发生率、麻黄素使用率、寒战发生率和恶心呕吐发生率明显低于B组（P〈0．05）；A组较B组最高阻滞平面到达时间长（P〈0．01）；2组最高阻滞平面及术后新生儿Apgar评分的差异无统计学意义（P〉0．05）。结论小剂量布比卡因复合芬太尼腰一硬联合麻醉是剖宫产手术较理想的麻醉选择。

Application of low doses of bupivacaine in combination with fentanyl on combined spinal epidural anesthesia in caesarean section

Objective To evaluate the application of low doses of bupivacaine in combination with fentanyl on com- bined spinal epidural anesthesia （CSEA） during caesarean section. Methods A total of 80 ASA Ⅰ - Ⅱ pregnant women, from 19 to 45 years old, underwent caesarean section. They were randomized into group A and group B （n = 40 in each）. In group A, CSEA was performed at L2 -3 or L3 -4 with 4.5 mg bupivacaine and 20μg fentanyl. In contrast, a conventional dose of 9 mg bupivacaine was adopted in group B. Then, the following data were recorded, namely hemody- namic variables （MAP, HR, and SpO2 ）, top blocked level, neonatal Apgar scores 1 and 5 minutes after birth, limb muscle strength and side effects. Results Compared with group B, group A reported lower rates of hypotension, less fre- quent use of ephedrine, lower incidence of nausea and vomiting or chill （ P 〈 0.05 ）. Group A also required longer period of time to reach the top blocked level than group B （ P 〈 0.01 ）. There were no significant differences between two groups in top blocked level and neonatal Apgar scores （ P 〉 0.05 ）. Conclusion Low doses of bupivacaine in combina- tion with fentanyl can provide satisfactory effects in combined spinal epidural anesthesia for cesarean section.