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上海市卫生健康委员会
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小剂量布比卡因复合舒芬太尼脊麻用于急诊剖宫产的临床观察
Clinical observation of small-dose bupivacaine combined with sufentanil for spinal anesthesia undergoing emergency cesarean section

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DOI:
作者:
许庆，张巍，瞿煦临，王晓瑛
XU Qing, ZHANG Wei, QU Xulin，WANG Xiaoying
作者单位:
浦东妇幼保健院
Shanghai Pudong Maternal and Infant Health Hospital
关键词:
布比卡因 舒芬太尼 脊麻 急诊剖宫产
Bupivacaine; Sufentanil; Spinal anesthesia; Emergency cesarean section
摘要:
目的 观察小剂量布比卡因复合舒芬太尼脊麻在急诊剖宫产手术中应用的可行性。方法 选择80例ASAⅠ～Ⅱ级单胎急诊剖宫产产妇，随机分为布比卡因复合舒芬太尼组（BS组）和布比卡因组（B组）。药物分别为0.5%布比卡因6mg加舒芬太尼5ug和0.5%布比卡因10mg。于L2～3行蛛网膜下腔麻醉。观察并记录患者麻醉前（T0）、给药后5min（T1）、10min（T2）、15min（T3）、30min（T4）及手术结束时（T5）MAP、HR、SPO2的变化。并记录脊麻阻滞平面及达到阻滞平面的时间、麻醉效果，术中低血压发生情况和麻黄素的使用情况，术中胸闷、恶心呕吐、寒战等不良反应以及新生儿娩出后1min、5minApgar评分。 结果与麻醉前T0相比较，B组T1～T5各时点MAP明显低于T0（p<0.05）,BS组MAP明显高于B组（P<0.05）。BS组脊麻阻滞平面明显低于B组、BS组低血压发生率，麻黄素使用率、恶心呕吐、寒战明显低于B组（p<0.05）。结论 0.5%布比卡因6mg加舒芬太尼5ug脊麻具有麻醉效果满意、不良反应较小等优点，可安全用于急诊剖宫产。
Objective To evaluate the feasibility of small-dose bupivacaine combined with sufentanil for spinal anesthesia undergoing emergency cesarean section. Methods eighty pregnant women（ASA Ⅰ～Ⅱ） with single fetus scheduled for emergency cesarean section were randomly divided into two groups with 40 cases in each group: group BS with 0.5% bupivacaine 6mg combined with sufentanil 5ug and group B with 0.5% bupivacaine 10mg. Spinal anesthesia was performed at L2～3 interspace. Mean arterial pressure (MAP), heart rate (HR) and Saturation of Peripheral Oxygen(SpO2) in all patients were observed and recorded before anesthesia（T0）, 5 min（T1）, 10 min（T2）, 15 min（T3）and 20min（T4） after anesthesia and at the end of the surgery（T5）. Maximum block level, time to reach that level, anesthetic effect, the incidence of intraoperative hypotension, the use of ephedrine, side effects including chest congestion, nausea and vomiting, chill and so on, and 1 min and 5 min Apgar scores in newborns were recorded as well. Results MAP was significantly lower at T1～T5 than that at T0 in group B(P<0.05). MAP was significantly higher at T1～T5 in group BS than that in group B (P<0.05). Compared with group B, Maximum block level in group BS decreased significantly (P<0.05). The incidences of hypotension, using ephedrine, nausea and vomiting, and chill were significantly lower in group BS than those in group B. Conclusion 0.5% bupivacaine 6mg combined with sufentanil 5ug offers the advantage of satisfactory anesthesia with fewer side effects. They can be used safely in emergency cesarean section.

 

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