| 摘要: |
| 目的 探讨重度子痫前期产妇剖宫产重比重布比卡因蛛网膜下腔阻滞麻醉（腰麻）的适合剂量。方法 选取200例重度子痫前期产妇，ASAⅠ级或Ⅱ级，按随机数字表法分为4组，每组各50 例，相应各组鞘内注入布比卡因剂量分别为10、8、6 及4mg，并混合2.5μg 舒芬太尼。选择L3~4行腰硬联合穿刺，注药10min 后记录麻醉平面。根据结果进行Probit 回归分析，计算布比卡因腰麻的ED50和ED95。观察各组利多卡因及去氧肾上腺素的用量、肌松效果及患者麻醉满意度，观察各组术中并发症以及新生儿的Apgar 评分和脐动脉pH。结果 重度子痫前期患者腰麻剖宫产布比卡因ED50 和ED95分别为：6.51（95%CI：5.81～7.01）和8.68（95%CI：7.96～10.26）。4 组患者10min 后麻醉平面的差异均有统计学意义（均P＜0.05）。4mg 组利多卡因用量高于其他3组，差异有统计学意义（P＜0.05）。8mg 组、10mg 组去氧肾上腺素的用量高于其他两组，差异均有统计学意义（均P＜0.05）。低血压的发生率8mg 组、10mg 组高于其他两组，差异均有统计学意义（均P＜0.05）。４ 组间其他不良反应恶心、呕吐、寒战以及心动过缓发生率的差异无统计学意义（P＞0.05）。4 组胎儿娩出后1、5min Apgar 评分及脐动脉血气分析的结果差异均无统计学意义（均P＞0.05）。结论 重度子痫前期产妇剖宫产鞘内注入6mg 布比卡因混合2.5μg舒芬太尼，必要时辅以硬膜外麻醉，麻醉效果确切，血流动力学稳定，适合该类患者手术麻醉。 |
| 关键词: 重度子痫前期 蛛网膜下腔阻滞 剖宫产 布比卡因 适合剂量 |
| DOI： |
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| 基金项目:嘉兴市科技局资助项目 |
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| Optimal dose of bupivacaine for cesarean delivery under combined spinal-epidural anesthesia in severe pre-eclamptic patients |
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XIAO Fei, XU Wenping, ZHANG Wangping, ZHANG Xiaomin, WANG Lizhong
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Jiaxing Maternity and Child Care Hospital
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| Abstract: |
| Objective To determine the optimal dose of intrathecal bupivacaine for severe pre-eclamptic patients undergoing elective cesarean delivery. Methods Two hundred severe preeclamptic patients were randomly allocated into one of four groups (n=50 in each). The doses of intrathecal bupivacaine were 4mg, 6mg, 8mg, and 10mg respectively. All patients received 2.5μg sufentanil intrathecally with bupivacaine. Combined spinal-epidural anesthesia was performed at L3~4, epidural catheter was placed and advanced 4cm into the epidural space in cephalad direction. The sensory block was recorded 10 min after intrathecal injection of bupivacaine and sufentanil. The ED50 and ED95 were calculated according to probit analysis. The dose of epidural lidocaine and intravenous phenylephrine were tested, and the muscle relaxation, intraoperative complications and patients'satisfaction were documented. Results The ED50 and ED95 of intrathecal bupivacaine were 6.51 (95%CI, 5.81~7.01) and 8.68 (95%CI, 7.96~10.26), respectively. The sensory block 10min after intrathecal injection was significantly different among groups (P＜0.05). The use of lidocaine in group 4mg was higher than that in other groups (P＜0.05). The use of phenylephrine in groups 8mg and 10mg was higher than that in other two groups(P＜0.05). The incidence of hypotension in groups 8mg and 10mg was higher than that in groups 4mg and 6mg (P＜0.05). The satisfaction of muscle relaxation in groups 4mg and 8mg was lower than that in other two groups (P＜0.05). There was no significant difference in patients' satisfaction, the Apgar score of newborns and the results of umbilical blood gas analysis (P＞0.05) among four groups. Conclusion Combined spinal and epidural anesthesia with dose of 6 mg bupivacaine and 2.5μg sufentanil can provide effective anesthesia and improve maternal hemodynamic stability for severe pre-eclamptic patients undergoing cesarean section. |
| Key words: Severe pre-eclampsia Spinal Cesarean section Bupivacaine Suitable dose |
