0.75%布比卡因复合吗啡与可乐定在剖宫产术中的麻醉效果

目的探讨0.75%布比卡因复合吗啡与可乐定在剖宫产术腰硬联合麻醉中的麻醉效果。方法采用随机双盲法,将132例择期行剖宫产手术的足月单胎产妇分为两组。A组(n=66):8.0 mg(1.6 ml)布比卡因+100μg(1.0 ml)吗啡+75μg(0.5 ml)可乐定;B组(n=66):8.0 mg(1.6 ml)布比卡因+100μg(1.0 ml)吗啡+0.5 ml生理盐水。记录两组的术前及术后的SBP、DBP、HR值的变化,感觉、运动阻滞起效时间,阻滞达到最高平面的时间,术中改良Bromage运动阻滞评分,新生儿出生后Apgar评分,术后的镇痛效果及麻醉并发症。结果两组在术前、术后5 min的SBP、DBP,HR值的变化、新生儿出生后Apgar评分比较,差异无统计学意义(P>0.05);两组运动阻滞起效时间、运动阻滞持续时间、术后镇痛时间比较,差异有统计学意义(P<0.05)。A组出现低血压8例(12.1%),B组出现低血压17例(25.8%),差异有统计学意义(χ2=11.16,P<0.05),两组均未发生其他不良反应。A组追加麻黄碱8例(12.1%),B组追加麻黄碱17例(25.8%),差异有统计学意义(χ2=10.58,P<0.05)。结论 0.75%布比卡因复合吗啡与可乐定应用于剖宫产腰硬联合麻醉可增强术中及术后镇痛效果,安全性高。

Anesthetic effect of 0.75% bupivacaine combined with morphine and clonidine during cesarean section

Objective To explore the anesthetic effect of 0.75% bupivacaine combined with morphine and clonidine during cesarean section with combined spinal epidural anesthesia. Methods 132 full-term single-fetus parturients with elective cesarean section were divided into the two groups using the randomized,double-blind approach.The group A （n=66） was given 8.0 mg （1.6 ml） bupivacaine ＋ 100 μg （1.0 ml） morphine ＋75μg （0.5ml） clonidine and the group B （n=66） was given 8.0 mg （1.6 ml） bupivacaine ＋ 100μg （1.0 ml） morphine ＋ 0.5 ml normal saline.The change of SBP, DBP and HR value before and after operation,the onset time of sensory and motor blocked,the time of blocking reach- ing the highest plane,the score of modified Bromage motor blocking during operation,Apgar score after the birth of new- born,analgesic effect and anaesthetic complications after operation of the two groups were recorded. Results There was no statistical difference of the change of SBP,DBP and HR before operation and after 5 min operation, Apgar score after the birth of newborn of the two groups （P〉O.05）;there was a statistical difference of the onset time of motor blocking, duration time of motor blocking, and time of postoperative analgesia of the two groups（P〈0.05）. 8 cases （12.1%） of hy- potension were observed in the group A and 17 cases （25.8%） of hypotension were observed in the group B and there was a statistical difference between the two groups （X2=11.16, P〈0.05）.No other adverse ractionss were observed in the two groups. Ephedrine was added for 8 cases （12.1%） in the group A and 17 cases （25.8%） in the group B nd there was a statistical difference between the two groups （X2=10.58, P〈0.05）. Conclusion 0.75% bupivacaine combined with mor- phine and clonidinein in spinal-epidural anesthesia during cesarean section can improve intraoperative and postopera- tive analgesic effect and ensure high safety.