摘要
目的探讨4种不同蛛网膜下腔布比卡因推注速度用于正常体质量产妇腰硬联合剖宫产麻醉的效果。方法将2017年10月至2018年9月昆明医科大学附属延安医院收治的160例择期正常体质量产妇分为A、B、C、D 4组(n=40例),常规于L3~4间隙行腰硬联合麻醉,分别于蛛网膜下腔注入0.75%布比卡因注射液11.5mg,硬膜外置管后协助产妇取平卧位。蛛网膜下腔注药后每2 min针刺皮肤法测定麻醉感觉阻滞平面,记录HR、SpO2及BP,密切观察有无不良反应如低血压、心动过缓、心动过速、恶心呕吐、胸闷的发生并及时处理。结果4组产妇的年龄、身高、体重、BMI值(kg/m2)比较无统计学差异(P>0.05),D组手术时间明显长于其他3组(P <0.05);A组、B组和C组麻醉起效时间、镇痛效果及肌松效果均优于D组(P <0.05);A组产妇在胎儿取出后及手术结束时的MBP均明显低于B和C组产妇,而在胎儿取出后的HR明显高于B和C组产妇(P <0.05);D组产妇硬膜外加药、静脉辅助用药及改全麻例数明显多于B组和C组(P <0.05)。结论在药物的浓度、剂量及穿刺点选择不变的情况下,按照0.75%布比卡因2 mL加脑脊液1 mL的方法配比,布比卡因11.5 mg腰麻10~15 s和15~20 s的推注速度均可有效用于正常体质量产妇剖宫产术,供临床麻醉参考。
Objective To explore the effects of four different injection times of bupivacaine in subarachnoid space combined with spinal-epidural cesarean section anesthesia for parturients with normal body mass. Methods From October 2017 to September 2018,160 normal weight parturients admitted to Yan’an Hospital Affiliated to Kunming Medical University were divided into four groups: A,B,C and D(n = 40 cases). Routine combined spinal-epidural anesthesia was performed in the interval of L3-4. 11.5 mg of 0.75%bupivacaine injection was injected into subarachnoid space respectively. After epidural catheterization, the parturients were assisted to take a horizontal position. The anesthesia sensation blocking plane was measured every 2 min. HR, SpO2 and BP were recorded, and the occurrence of adverse reactions such as hypotension, bradycardia, tachycardia, nausea, vomiting and chest distress was closely observed and handled in time. Results There were no significant differences in age, height, weight and BMI(kg/m2)among the four groups(P > 0.05). The operation time in group D was longer than those of the other three groups( P < 0.05), and the anesthesia onset time, analgesic effects and muscle relaxation effects in group A, group B and group C were better than those of group D(P < 0.05). MBP in group A was significantly lower than that in group B and C after the fetus was taken out and at the end of the operation, while HR in 5 minutes after injection was significantly higher than that in group A and B(P < 0.05). But HR was significantly higher after the fetus was taken out than those in group B and C(P < 0.05). The numbers of cases of epidural medication, intravenous adjuvant medication and general anesthesia in group D were significantly higher than those in group B and C(P < 0.05). Conclus ions With the same drug concentration, dosage and puncture site, with 2 ml of 0.75 % bupivacaine plus 1 ml of cerebrospinal fluid, 10-15 seconds’ and 15-20 seconds’ injection rates of bupivacaine 11.5 mg for normal body mass parturients under spinal anesthesia can both be effectively in cesarean section.
作者
朱毓玲
刘萍
张富荣
马元平
ZHU Yu-ling;LIU ping;ZHANG Fu-rong;MA Yuan-ping(Dept. of Anesthesia,Kunming Yan'an Hospital,Kunming Yunnan 650051,China)
出处
《昆明医科大学学报》
CAS
2019年第5期63-67,共5页
Journal of Kunming Medical University
基金
云南省临床重点专科建设基金资助项目(2017)
关键词
剖宫产
腰硬联合麻醉
推注速度
体质量指数
Cesarean section
Combined spinal-epidural anesthesia
Injection time
Body mass index
