【摘要】 目的探讨不同浓度、剂量氯普鲁卡因用于产科脊麻的效果。方法117例经L2～3脊间隙行脊麻-硬膜外联合穿刺麻醉的产妇随机分为A(n=39)、B(n=40)、C(n=38)三组,分别向蛛网膜下腔注入(针斜面向尾)氯普鲁卡因合剂2.0ml(2.5%氯普鲁卡因1.0ml+10%葡萄糖0.5ml+3%麻黄碱0.5ml)、2.2ml(2.5%氯普鲁卡因1.2ml+10%葡萄糖0.5ml+3%麻黄碱0.5ml)和2.0ml(3%氯普鲁卡因1.0ml+10%葡萄糖0.5ml+3%麻黄碱0.5ml)。注射时间为35s。结果①麻醉起效时间C组明显快于A组(P﹤0.05)。达到T11无痛时间、双下肢不能抬起时间、最高阻滞平面时间,C组均快于A、B两组,但无显著性差异。最高阻滞平面C组(T3.00±0.47)平均高出A(T4.50±1.13)、B(T4.05±1.38)组一个节段。②麻醉消退至T11时间、双下肢能抬起时间、麻醉完全消失时间A、B两组相似,而C组明显较长(P﹤0.01)。③三组术中均无产妇诉疼痛,术者感觉腹肌均非常松弛。④麻醉后出现低血压(SP﹤80mmHg或下降﹥基础值30%)A、B、C三组分别为13例(33%)、16例(40%)、20例(52%),均给予麻黄碱纠正。心率相对稳定,SpO2正常。⑤麻醉后恶心、呕吐随氯普鲁卡因剂量或浓度的升高而增加。⑥117例患者至出院时均未见任何精神神经系统不良反应。结论三组国产氯普鲁卡因合剂用于产科脊麻均产生满意的临床麻醉效果,但随氯普鲁卡因剂量或浓度的增加其产生低血压和恶心、呕吐的发生率增加。剖宫产选择氯普鲁卡因脊麻合剂用A组即可。更多还原

【Abstract】 Objective To study the efficacy of various density and dosage of chloroprocaine for spinal anesthesia in obstetrics. Methods 117 primiparas with full-term pregnancy were divided randomly into group A(n=39)、B(n=40) and C(n=38),All were punctured from lumbar 2~3 spinal interspace,and injected a mixture of 2.0 ml (2.5% chloroprocaine 1.0 ml,10% glucose 0.5 ml,3% ephedrine 0.5 ml) or 2.2 ml(2.5% chloroprocaine 1.2 ml,10% glucose 0.5 ml,3% ephedrine 0.5 ml) or 2.0 ml (3% chloroprocaine 1.0 ml,10% glucose 0.5 ml,3% ephedrine 0.5 ml) within 35 seconds into subarachnoid space,respectively. Results ① The onset times of Group C was significantly faster (P﹤0.05) than group A. Time to arrive at thoracic 11 level pain-free,time for unable to lift lower limbs,time to reach the highest nerve block levels were faster (no significant difference statistically) in group C than other groups. The highest mean nerve block levels were thoracic 4.50±1.31,4.05±1.38 and 3.00±0.47 in group A、B and C,respectively. ② Time of nerve block fade to thoracic 11 level,time for lower limbs able to lift up and time of anesthesia complete disappearance were longer significantly (P﹤0.01) in group C than those in other groups. ③ No one of primiparas in all groups had surgical pain,and all primiparas’ abdominal muscles were profoundly relaxed. ④ The incidence of hypotension in group A、B and C was 33%(13/39)、40%(16/40) and 52%(20/38),respectively,and could be effectively corrected by ephedrine. ⑤ Occurrence of nausea and vomiting was increased with increasing density or dosage of chloroprocaine. ⑥ No behavior changes could be observed. Conclusions The three mixtures of chloroprocaine can produce satisfactory spinal anesthesia for cesarean,but hypotension,nausea and vomiting are increased with incrersed dosage or density of chloroprocaine. The mixture of 2.5% chloroprocaine 1.0 ml,10% glucose 0.5 ml,3% ephedrine 0.5 ml is satisfactory for spinal anesthesia in cesarean.更多还原