【摘要】 目的 :临床观察小剂量腰麻复合硬膜外麻醉在剖宫产手术的可行性。方法 :年龄 2 2～ 35岁单胎孕妇 6 0例 ,随机分为硬膜外组 (Y组 )腰—硬联合组 (L组 )及单纯腰麻组 (D组 ) ,每组 2 0例。分别注入 0 .75 %布比卡因 2ml+5 %葡萄糖 1ml混和液 1.2ml(L组 )或 2ml(D组 ) ,当L组平面不理想时硬膜外给 2 %利多卡因 5～ 15ml。Y组在L2～ 3 间隙硬膜外穿刺 ,给 2 %利多卡因10ml。用针刺法测感觉平面。运动阻滞的程度用改良的Bromage评分法 ,观察恶心、呕吐和会阴牵拉感及需给麻黄素发生率。结果 :Y组和L组在BP、HR、ECG、SPO2 上均无显著差异 (P >0 .0 5 )。与其他两组比较 ,D组有血压下降 ,部分孕妇出现恶心、呕吐和需要给麻黄素的机率明显升高 (P <0 .0 5 )。感觉阻滞上平面 :Y组T8与L组T7无显著差异 (P >0 .0 5 ) ;与D组T5有显著差异 (P <0 .0 5 )。阻滞下平面 :L组与D组S5无显著差异 ;Y组有个别为S3 孕妇有牵拉感觉。运动阻滞 :按Bromage评分法 3组无显著差异 (P >0 .0 5 ) ,但Y组和L组明显优于D组。恶心、呕吐和需要给麻黄素发生率L组明显优于D组 (P <0 .0 5 )。结论 :小剂量腰麻复合硬膜外麻醉是在剖宫产手术中较单纯硬膜外和单纯腰麻更加优越的麻醉方法 ,可安全用于剖宫产手术。更多还原

【Abstract】 Objective: Evaluate the effect and safety of low dose 0.75% bupivacaine for combined spinal and epidural anesthesia for cesa rean section.Methods:sixty patients(ASAⅠ-Ⅱ) scheduled for cesarean section were divided into three groups epidural group (Y group) received 2% lidocaine 10 -15ml at epidural space only; spinal group (D group) received 0.75% bupivacaine 2ml and 5% glucose 1ml mixture solution 2ml; epidural combined spinal group (L g roup) received 0.75%bupivacaine 2ml and 5% glucose 1ml mixture solution 1.2ml an d if the sensitive block level was not attached the target level, 10-15ml 2% lid ocaine was needed. The sensory block were measured by pin puncture, the motor le vel were evaluated by modified Bromage scale methods. Nouse and Vomiting of pati ents as well as other side effects were recorded. Results: There are no significant difference among three groups in age, height, body weight and duration of operation (P>0.05). Compared w ith Y and D group, L group has no difference in high sensory level(P>0.05) ,but has significant difference in low sensory level(P<0.05).There are no significance among three groups in motor block level(P>0.05),but perineum involving sensor was noticed in Y group. Compared with Y and L group, D group ha s high rate of low blood pressure. Rate of nausea and vomiting was high in D gro up, compared with Y and L group.Conclusion:Low dose 0.75% bupivacaine for combined spinal and ep idural anesthesia for cesarean section is safety and effective anesthesia.更多还原