腰麻-硬膜外联合阻滞用于二次剖宫手术的临床观察

【摘要】 目的评价腰麻-硬膜外联合阻滞麻醉用于二次剖宫产手术的临床效果,并以硬膜外麻醉方法作为对照。方法选择择期二次剖宫手术病人61例,26￣40岁,ASAⅠ￣Ⅱ级,随机分为腰-硬联合阻滞组(Ⅰ组,n=30)和硬膜外麻醉组(Ⅱ组,n=31),Ⅰ组用0.75%罗哌卡因2ml和50%GS 0.5ml及3%麻黄碱0.5ml配成重比重液,用DurasafeTM型联合阻滞配套针于L2-3间隙穿刺,以0.1ml/秒的速率蛛网膜下腔给药1.8ml￣2.3ml,术中酌情给予2%利多卡因维持麻醉。Ⅱ组用0.75%罗派卡因,L2-3间隙穿刺,硬膜外腔置管,总用药量为(87.1±20.1)mg。比较两组术中镇痛和腹壁肌松质量,并观察用药后的不良反应。结果Ⅰ组术中镇痛和腹壁肌松质量明显优于Ⅱ组,观察中无严重不良反应。结论由于第一次剖宫产手术后粘连导致二次手术时肌松、镇痛效果差,而腰-硬阻滞能达到较为完善的麻醉效果。更多还原

【Abstract】 Objective To evaluate the clinical efficacy in combined spinal-epidural anesthesia(CSEA) versus in epidural anesthesia in patients the second undergoing caesarean section.Methods Sixty-one patients,ASA class Ⅰ-Ⅱ,26 to 40 years,the second undergoing caesarean section were randomly designed to receive respectively during caesarean section in combined spinal-epidural anesthesia(group Ⅰ,n=30) or epidural anesthesia(group Ⅱ,n=31).In group Ⅰ the patients were received spinally hyperbaric mixture 1.8ml~2.3ml,combined with 0.75% ropivacaine 2ml and 50% glucose 0.5ml and 3% ephidrine 0.5ml,and the anesthesia was maintained with epidural administration with 2% lidocaine if necessary during the operation,after the B-D.Durasafe TM combined spinal epidural anesthesia kit was applied at the L2-3 interspace.In group Ⅱ the patients were received 0.75% ropivacaine altogether dosage(87.1±20.1)mg epidural anesthesia applied at the L2-3 interspace.Quality of analgesia and abdominal wall relaxation were assessed together with adverse event.Results the quality of analgesia and abdominal wall relaxation were better in grout Ⅰthan those in group Ⅱ(p<0.05-0.01).No severe adverse event was found during the observations.Conclusion CSEA is safe and effective for combined spinal-epidural anesthesia.更多还原