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目的观察腰硬联合阻滞(CSEA)下行剖宫产术鞘注不同剂量布比卡因、舒芬太尼的效应,探讨二者复合应用的合适剂量。方法将200例产妇按鞘内注药的不同随机分为5组,A、B、C、D、E组;布比卡因剂量依次递减,分别为10、9、8、7、6mg;复合舒芬太尼剂量依次递加,分别为0、3、4、5、6μg。观察比较各组麻醉效果、不良反应、新生儿Apgar评分以及注药后感觉、运动神经阻滞持续时间。结果A组血压下降,同时伴恶心或呕吐,17例(42·5%)在加快输液的同时需升压药处理,与麻醉前比较差异有统计学意义(P<0·05),注药后感觉、运动神经阻滞时间在3h以上,与C、D、E组比较差异具有统计学意义(P<0·05)。C、D组循环稳定,产妇安静,无恶心、呕吐等不良反应,麻醉效果满意,感觉、运动神经阻滞持续时间缩短,C、D组与A组比较差异具有统计学意义(P<0·05)。E组肌松较差。结论腰硬联合阻滞用于剖宫产术鞘注布比卡因7～8mg复合舒芬太尼4～5μg比较合适。
Objective To observe the effect of different doses of bupivacaine and sufentanil on CSEA descending cesarean section and to explore the appropriate dosage for their combined application. Methods 200 maternal women were randomly divided into five groups according to the intrathecal injection: group A, B, C, D and E; the dose of bupivacaine was decreased by 10, 9, 8, 7 and 6 mg respectively; Sufentanil dose followed by increasing, respectively, 0,3,4,5,6 g. The effects of anesthesia, adverse reactions, neonatal Apgar score, sensation after injection, duration of motor block were observed and compared. Results In group A, the blood pressure decreased accompanied with nausea or vomiting, and 17 cases (42.5%) were required to be treated with antihypertensive drugs while accelerating the infusion. The difference was statistically significant (P <0.05) After exercise, the motor nerve block time was above 3h, which was significantly different from that of C, D and E groups (P <0.05). C, D group was stable, maternal quiet, no nausea, vomiting and other adverse reactions, satisfactory anesthesia, feeling, duration of motor nerve block shortened, C, D group compared with the A group was statistically significant (P <0 · 05). E group muscle relaxation is poor. Conclusion Combined spinal-epidural blockade is suitable for cesarean delivery of 4-8 μg of bupivacaine combined with 7-8 mg of sufentanil.