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两种重比重液蛛网膜下腔阻滞对剖宫产患者麻醉效果的影响 被引量:1

Effect of Two Hyperbaric Solutions for Subarachnoid Block on Caesarean Section
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摘要 【目的】探讨两种重比重液在剖宫产术蛛网膜下腔阻滞应用中的的麻醉效果及其对病人术中血流动力学的影响。【方法】择期单胎剖宫产术病人100例,ASAI~Ⅱ级,随机分为A组(5%葡萄糖稀释的0.5%布比卡因,比重1.0107),B组(10%葡萄糖稀释的0.5%布比卡因组,比重1.0160),每组50例,用腰硬联合麻醉技术(CSEA)的针内针法经L2~3实施腰麻,均采用0.5%布比卡因2.5mL。测定和评价术中麻醉质量和肌松效果,比较两组患者术中血流动力学的变化、麻醉起效时间、感觉阻滞的峰平面、达最高感觉阻滞平面的时间、运动阻滞Bromage评分达3级的时间,阻滞后低血压、心动过缓、呼吸抑制(SpO2〈90%)的情况,使用麻黄碱和阿托品的总量和例数。【结果】两组注药后麻醉起效时间、麻醉质量和肌松效果差异、新生儿Apgar评分差异无统计学意义(P〉O.05);两组运动阻滞达改良Bromage评分3级的时间、两组感觉阻滞达峰平面的时间A组迟于B组;感觉阻滞的最多节段数(Dmax)A组少于B组,差异有统计学意义(P〈0.05),低血压和心动过缓或出现恶心、呕吐等不良反应发生率和使用麻黄素、阿托品总量和例数,A组显著少于B组(P〈0.05);A组给药后平均动脉压(MAP)最低值的出现时间、下降幅度与B组比较有统计学差异(P〈0.05),A组变化趋于平缓。【结论】比重为1.0107腰麻液对产妇的血流动力学影响小,应用于剖宫产手术更显其优点。 [Objective] To investigate the anesthesia effect and safety of two hyperbaric solutions for spinal anesthesia on caesarean section. [Methods] A total of 100 ASA Ⅰ~Ⅱ pregnant woman undergoing elective caesarean section under spinal anesthesia by using CSEA technique via spinal needle in epidural needle were randomly divided into 2 groups with 50 patients in each group. Group A received subarachnoid injection of 0. 5% bupivacaine 2.5ml diluted by 5% glucose solution which the specific gravity was 1. 0107. Group B received subarachnoid injection of 0.5% bupivacaine 2.5ml diluted by 10% glucose solution which the specific gravity was 1. 0160. The quality of anesthesia and the effect of muscle relaxation during operation were measured and assessed. The changes of hemodynamics, the onset time of anesthesia, the peak plane of sensation block, the time to reach the peak sensation block, the time of motor block with Bromage score 11 , the incidence of hypotension, bradycardia and respiratory depression(SpO2 〈90 % after blockage and the total usage dose of ephedrine and atropine were recorded and compared. [Results] There was no statistical difference on basic conditions ( P 〉0.05). There was no significant difference on the onset time of sensation block, anesthesia effectiveness and Apgar score in two groups ( P 〉0.05), but the time of motor block with modified Bromage score Ⅲ and the peak plane of anesthesia in group A were slower than thosr in group B, and the plane of anesthesia in group A was significantly iower than that in group B ( P 〈0.05). The incidence of adverse reactions and the usage dose of ephedrine and atropine in group A were lower than those in group B( P 〈0.05), and the change of mean arterial pressure (MAP) in group A was more smooth than that in group B( P 〈0.01). [Conclusion]Spinal anesthesia with hyperbaric bupivacaine solution which the specific gravity is 1. 0107 has stable hemodynamic parameters and the lower incidence of adverse reactions on caesarea
出处 《医学临床研究》 CAS 2009年第11期2104-2106,共3页 Journal of Clinical Research
关键词 剖宫产术 麻醉 产科 神经传导阻滞 蛛网膜下腔 cesarean section anesthesia,obstetrical nerve block subarachnoid space
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