目的 探讨等比重盐酸布比卡因在横切口剖宫产术中的最适剂量.方法 选择2014年3月至2015年1月航天中心医院拟行剖宫产术孕妇160例,采用随机数字表法分成A、B、C、D4组,各40例.选择L2~3间隙穿刺,蛛网膜下腔-硬膜外联合麻醉.蛛网膜下腔麻醉药物选择0.75%盐酸布比卡因,经脑脊液稀释至0.5%浓度后推注,4组分别给予1.5、2.0、2.5、3.0 ml.比较4组麻醉效果、低血压、恶心呕吐发生情况以及硬膜外药物追加情况.结果 C、D组多数患者在单次蛛网膜下腔麻醉给药后麻醉阻滞效果为优[92.5% (37/40)、95.0%(38/40)],与A、B组比较[57.5%(23/40)、72.5% (29/40)],差异均有统计学意义(均P<0.05).D组产妇术中低血压及恶心呕吐发生率明显高于A、B、C组[低血压:30.0%(12/40)比10.0%(4/40)、12.5% (5/40)、15.0%(6/40),恶心呕吐:25.0%(10/40)比12.5%(5/40)、10.0%(4/40)、12.5% (5/40)],差异均有统计学意义(均P<0.05),C组与A、B组比较,差异无统计学意义(P>0.05).C、D组产妇硬膜外药物追加率[7.5% (3/40)、5.0%(2/40)]明显低于A、B组[42.5% (17/40)、27.5% (11/40)],差异均有统计学意义(均P<0.05),但A、B组比较差异无统计学意义(P>0.05).结论 以0.5%盐酸布比卡因2.5 ml行蛛网膜下腔麻醉,可以更好地满足横切口剖宫产手术麻醉要求.
Objective To explore the optimal dose of isobaric bupivacaine in cesarean section with transverse incision.Methods Totally 160 pregnant women who underwent caesarean section from March 2014 to January 2015 were randomly divided into group A, B, C, D (40 cases in each group).L2-3 gap puncture was done and combined spinal epidural anesthesia was performed with 0.5% isobaric bupivacaine, the injected volume in spinal was 1.5, 2.0, 2.5 and 3.0 ml in group A, B, C and D.The anesthesia effect, incidences of hypotension, nausea and vomiting, additional rate of epidural drugs were observed and compared among groups.Results The rates of perfect anesthesia after single spinal anesthesia in group C and D were significantly higher than those in group A and B [92.5% (37/40), 95.0% (38/40)vs57.5% (23/40), 72.5% (29/40)] (P<0.05).The incidences of hypotension, nausea and vomiting in group D were obviously higher than those in group A, B and C [30.0% (12/40) vs 10.0% (4/40), 12.5% (5/40), 15.0% (6/40);25.0% (10/40) vs 12.5% (5/40), 10.0% (4/40), 12.5% (5/40)] (P <0.05), while no significant differences were found between group C and group A, group C and B (P > 0.05).The rates of epidural drugs in group C and D were significantly lower than those in group A and B [7.5% (3/40), 5.0% (2/40) vs 42.5% (17/40), 27.5% (11/40)] (P <0.05), and no statistical difference was shown between group A and B (P > 0.05).Conclusion In cesarean section with transverse incision, 2.5 ml of 0.5% bupivacaine hydrochloride used in subarachnoid space injection can be effective.