摘要
目的探讨布比卡因腰硬联合麻醉在剖宫产中的较小剂量。方法选择ASAⅠ～Ⅱ级头位单胎足月妊娠初产妇90例。随机分成小剂量组(L组)、中剂量组(M组)和常规剂量组(N组),每组30例。于L3～4或L2～3穿刺,用0.75%布比卡因2ml+10%葡萄糖1ml配成重比重液3ml备用。小剂量组于蛛网膜下腔注入1.2ml,中剂量组注入1.5ml,常规剂量组注入2ml,速度为1ml/5s,腰麻阻滞平面低于T8,术中酌情于硬膜外追加1.6%利多卡因5～10ml,采用视觉模拟镇痛法(VAS)进行评价镇痛效果,用MBS(Modified Bromage Score)评分进行评价下肢运动神经传导阻滞,记录感觉阻滞起效时间、运动阻滞起效时间、最高镇痛平面出现时间、最大运动阻滞程度、最大运动阻滞时间和感觉恢复时间,并记录发生不良反应的例数。结果三组镇痛效果无显著差异;三组感觉阻滞起效时间、运动阻滞起效时间、最高镇痛平面出现时间、最大运动阻滞程度、最大运动阻滞时间无显著差异;L组较M组和N组的最高镇痛平面低1～2个平面;L组和M组感觉恢复时间较N组快,有显著差异;L组较N组的不良反应降低,有显著差异。结论小剂量布比卡因腰硬联合麻醉在剖宫产的应用效果满意,不良反应降低,并且安全性提高,值得临床推广应用。
Objective To study the low dosage of bupivicaine in combined spinal and epidual anesthesia in cesarean. Methods Ninety primiparas were divided into three groups at random：low dosage group （L group）, intermediate dosage group （M group）, and normal dosage group （N group）, （n = 30 each）. The point of puncture was L3-4 or L2-3, and 0. 75% bupivicaine （2 ml） and 10% glucose （1 ml） were mixed as heavy specific gravity solution. L group was injected （1.2 ml） to subarachnoid cavity, M group 1.5 ml, and N group 2 ml, respectively. 1. 6% lidocaine was added into epidural cavity if necessary. The analgesia effect was evaluated by visual simulation analgesia （VAS）, and the effect of the motor nerve block of the lower limb was assessed by Modified Bromage Score （MBS）. Results No significant differences in analgesic effect, the onset of the sensory nerve and the motor nerve, the first time of the highest analgesia level, the highest effect of the motor never block and the most last time of the motor never block were observed among three groups, the highest analgesia level was 1-2 level lower in L group than in M group and N group. There was significant difference in adverse reactions between L group and N group. Conclusion The application of low dosage of bupivacaine in combined spinal and epidual anesthesia in cesarean is comfortable. It can lower the adverse reactions, and increase the safety.
出处
《华中医学杂志》
2009年第3期154-156,共3页
Central China Medical Journal
关键词
布比卡因
腰硬联合麻醉
剖宫产术
剂量
Bupivacaine
Combined spinal-epidural anesthesia
Cesarean
Dosage
