小剂量盐酸布比卡因联合芬太尼对蛛网膜下腔阻滞在剖宫产中临床应用
|
摘要
目的分析小剂量盐酸布比卡因联合芬太尼对蛛网膜下腔阻滞在剖宫产手术中的应用效果。方法选取200例本院孕周>37+周待产单胎产妇,随机分为研究组盐酸布比卡因联合芬太尼组[0.5%盐酸布比卡因6mg(1.2mL)+芬太尼20μg(0.4mL)和对照组盐酸布比卡因组0.5%盐酸布比卡因10mg(2mL)]均在L3及L4间隙行蛛网膜下腔阻滞麻醉,每组各100例。分别于T0(麻醉前),给药后T1(5min)、T2(10min)、T3(15min)、T4(30min),和T5(手术结束时)对产妇的心率、MAP及时记录;对比新生儿1、5min Apgar评分;分析术中两组麻黄素的使用及寒战、牵拉痛、恶心呕吐及低血压等不良反应发生率的情况。结果研究组各时点的MAP无统计学差异(P>0.05);对照组T1-T5时间点与本组T0的MAP差异有统计学意义(P<0.05);研究组在T1-T5的MAP较对照组同时间点MAP均高(P<0.05);两组各时间点心率在组间、组比较,差异均无统计学意义(P>0.05);研究组的低血压、恶心呕吐、牵拉痛、寒战的发生率及麻黄素使用率均低于对照组(P<0.05);两组新生儿1、5 min Apgar评分比较,差异无统计学意义(P>0.05)。结论 0.5%盐酸布比卡因6mg联合芬太尼20μg蛛网膜下腔阻滞麻醉用于剖宫产术血液动力学稳定,不良反应少,临床值得运用。
Objective To analyze the effect of low-dose bupivacaine hydrochloride combined with fentanyl on subarachnoid block in cesarean section.Methods 200 cases of gestational age>37+ weeks of single-fetal birth were selected and randomly divided into study group bupivacaine hydrochloride combined with fentanyl group[0.5% bupivacaine hydrochloride 6 mg(1.2 mL)+ fentanyl 20μg(0.4 mL)and the control group bupivacaine hydrochloride 0.5% bupivacaine hydrochloride 10 mg(2 mL)]in the L3 and L4 gap in the subarachnoid space[drug application concentration indicates the corresponding application capacity should be indicated]block anesthesia,100 cases each.Before T0(before anesthesia),T1(5 min),T2(10 min),T3(15 min),T4(30 min),and T5(at the end of surgery),the heart rate and MAP of the mother were recorded in time;1,5 min Apgar score;analysis of the use of ephedrine in the two groups and the incidence of adverse reactions such as chills,traction pain,nausea and vomiting and hypotension.Results There was no significant difference in MAP between the study groups at each time point(P>0.05).There was significant difference between the T1 and T5 time points of the control group and the MAP of the T0 group(P<0.05).The MAP of the study group at T1-T5 was better than that of the control group.The MAP at the same time was significantly higher(P<0.05).There was no significant difference in the snack rate between the two groups(P>0.05).The study group had hypotension,nausea and vomiting,and traction.The incidence of pain,chills and ephedrine use were significantly lower than the control group(P<0.05).There was no significant difference in the Apgar scores between the two groups(P>0.05).Conclusion 0.5% bupivacaine hydrochloride 6 mg combined with fentanyl 20μg subarachnoid block anesthesia for cesarean section hemodynamic stability,less adverse reactions,clinically worthy of application.
Objective To analyze the effect of low-dose bupivacaine hydrochloride combined with fentanyl on subarachnoid block in cesarean section.Methods 200 cases of gestational age>37+ weeks of single-fetal birth were selected and randomly divided into study group bupivacaine hydrochloride combined with fentanyl group[0.5% bupivacaine hydrochloride 6 mg(1.2 mL)+ fentanyl 20μg(0.4 mL)and the control group bupivacaine hydrochloride 0.5% bupivacaine hydrochloride 10 mg(2 mL)]in the L3 and L4 gap in the subarachnoid space[drug application concentration indicates the corresponding application capacity should be indicated]block anesthesia,100 cases each.Before T0(before anesthesia),T1(5 min),T2(10 min),T3(15 min),T4(30 min),and T5(at the end of surgery),the heart rate and MAP of the mother were recorded in time;1,5 min Apgar score;analysis of the use of ephedrine in the two groups and the incidence of adverse reactions such as chills,traction pain,nausea and vomiting and hypotension.Results There was no significant difference in MAP between the study groups at each time point(P>0.05).There was significant difference between the T1 and T5 time points of the control group and the MAP of the T0 group(P<0.05).The MAP of the study group at T1-T5 was better than that of the control group.The MAP at the same time was significantly higher(P<0.05).There was no significant difference in the snack rate between the two groups(P>0.05).The study group had hypotension,nausea and vomiting,and traction.The incidence of pain,chills and ephedrine use were significantly lower than the control group(P<0.05).There was no significant difference in the Apgar scores between the two groups(P>0.05).Conclusion 0.5% bupivacaine hydrochloride 6 mg combined with fentanyl 20μg subarachnoid block anesthesia for cesarean section hemodynamic stability,less adverse reactions,clinically worthy of application.
引文
[1] 岳琪.腰-硬联合阻滞、硬膜外阻滞及蛛网膜下腔阻滞用于剖宫产的临床效果[J].中国药物经济学,2015(2):99-101.
[2] 潘麒,陈安基,黄丹,等.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[J].医学临床研究,2009,26(11):2104-2106.
[3] 汪愫洁,景宇淼,徐铭军.barbotage注射法和单次注射法应用于剖宫产蛛网膜下腔-硬膜外联合麻醉的比较[J].国际麻醉学与复苏杂志,2018(4).
[4] 汪愫洁,邹璐雯,徐铭军.剖宫产中影响局麻药在蛛网膜下腔扩散的因素[J].中国医刊,2016,51(8):16-18.
[5] 程英莉,吴建平,卢银军,等.罗哌卡因与布比卡因对剖宫产手术腰-硬联合麻醉患者血流动力学的影响[J].中国临床药理学杂志,2016,32(6):526-528.
[6] 安小虎,徐韬,王苑,等.小剂量布比卡因复合芬太尼腰一硬联合麻醉用于急诊剖宫产的临床观察[J].临床麻醉学杂志,2011,27(5):461-463.
[7] 张国辉.不同麻醉体位蛛网膜下腔阻滞硬膜外阻滞联合麻醉对剖宫产产妇及其新生儿影响[J].临床误诊误治,2016,29(11):108-110.
[8] 叶青山,王玲玲,郎淑惠,等.剖宫产术病人布比卡因-芬太尼等比重液蛛网膜下腔阻滞的效果[J].中华麻醉学杂志,2009,29(1):84-85.
[9] 余奇劲.两种蛛网膜下腔阻滞麻醉方案在高龄产妇剖宫产手术中的应用效果比较[J].广西医学,2018(1):51-54.
[10] 江平,崔宇宏,张桂芳.小剂量布比卡因蛛网膜下腔阻滞用于剖宫产术中低血压的预防与处置[J].齐齐哈尔医学院学报,2000(4).
[11] 刘永彬,丁冠男.低剂量布比卡因联合芬太尼腰麻在剖宫产术中的应用[J].临床和实验医学杂志,2016,15(7):708-711.
[12] 徐韬,王莉,余大松,等.腰硬联合蛛网膜下腔注射芬太尼用于分娩镇痛的半数有效剂量的临床研究[J].现代生物医学进展,2015,15(5):861-865.
[2] 潘麒,陈安基,黄丹,等.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[J].医学临床研究,2009,26(11):2104-2106.
[3] 汪愫洁,景宇淼,徐铭军.barbotage注射法和单次注射法应用于剖宫产蛛网膜下腔-硬膜外联合麻醉的比较[J].国际麻醉学与复苏杂志,2018(4).
[4] 汪愫洁,邹璐雯,徐铭军.剖宫产中影响局麻药在蛛网膜下腔扩散的因素[J].中国医刊,2016,51(8):16-18.
[5] 程英莉,吴建平,卢银军,等.罗哌卡因与布比卡因对剖宫产手术腰-硬联合麻醉患者血流动力学的影响[J].中国临床药理学杂志,2016,32(6):526-528.
[6] 安小虎,徐韬,王苑,等.小剂量布比卡因复合芬太尼腰一硬联合麻醉用于急诊剖宫产的临床观察[J].临床麻醉学杂志,2011,27(5):461-463.
[7] 张国辉.不同麻醉体位蛛网膜下腔阻滞硬膜外阻滞联合麻醉对剖宫产产妇及其新生儿影响[J].临床误诊误治,2016,29(11):108-110.
[8] 叶青山,王玲玲,郎淑惠,等.剖宫产术病人布比卡因-芬太尼等比重液蛛网膜下腔阻滞的效果[J].中华麻醉学杂志,2009,29(1):84-85.
[9] 余奇劲.两种蛛网膜下腔阻滞麻醉方案在高龄产妇剖宫产手术中的应用效果比较[J].广西医学,2018(1):51-54.
[10] 江平,崔宇宏,张桂芳.小剂量布比卡因蛛网膜下腔阻滞用于剖宫产术中低血压的预防与处置[J].齐齐哈尔医学院学报,2000(4).
[11] 刘永彬,丁冠男.低剂量布比卡因联合芬太尼腰麻在剖宫产术中的应用[J].临床和实验医学杂志,2016,15(7):708-711.
[12] 徐韬,王莉,余大松,等.腰硬联合蛛网膜下腔注射芬太尼用于分娩镇痛的半数有效剂量的临床研究[J].现代生物医学进展,2015,15(5):861-865.