肾上腺素在蛛网膜下腔麻醉中价值.docVIP

肾上腺素在蛛网膜下腔麻醉中的价值 Effects of Adrenaline in Spinal Anesthesia 徐朝辉 王久荣 XU Chaohui WANG Jiurong 天津市第一医院 Tianjin First Hospital 中分类号：R614.4+1 文献标识码：A 文章编号1818－0086（2008）05 摘 要:目的 探讨在不同平面布比卡因腰麻时局麻药中加入肾上腺素对麻醉效果的影响。方法 选择腰麻下手术患者85例，随机分为肾上腺素组A（腹部手术），肾上腺素组B（下肢手术），布比卡因组A（腹部手术），布比卡因组B（下肢手术）。腰麻穿刺成功后注入0.6%布比卡因15mg（0.75%布比卡因2ml+10%葡萄糖0.5ml），肾上腺素组另加入肾上腺素0.1mg。检测 注药后血压，感觉阻滞时间，阻滞持续时间，恶心呕吐以及寒战例数。结果 A组肾上腺素组较单纯应用布比卡因组血压波动小，感觉阻滞时间长较少发生恶心呕吐及寒战。B组之间无明显差异。结论 肾上腺素在高位腰麻时可有效减轻、减缓局麻药对血流动力学的干扰，减少恶心呕吐及寒战例数，延长阻滞持续时间。 关键词：肾上腺素；布比卡因；腰麻 to explore the reasonable type of bupivacaine to be mixed with adrenaline in lumbar anesthesia for different anesthetic level. Methods eighty-five patients with lumbar anesthesia were randomly divided into four groups. Bupivacaine group A (abdominal surgeries) and Bupivacaine group B (lower limb operations) received subarachoid cavity 0.6% bupivacaine 15mg (0.75%Bupivacaine 2ml+10%Glucose 0.5ml) injected respectively. Adrenaline group A (abdominal surgeries) and Adrenaline group B (lower limb operations) received the same local anesthetics containing Adrenaline 0.1mg. Blood pressure, sensory block, starting time and persisting time of sensory nerve block were recorded after injecting the local anesthetics. Results group A with adrenaline had the less influence on Bp and side reactions than the bupivacaine groups (P0.05). Conclusion in lumber anesthesia with higher level, bupivacaine containing adrenaline can significantly decrease the influence on hemodynamic and the incidence of nausea, vomiting and shiver. Bupivacaine with adrenaline also can increase the persisting time of sensory nerve block in higher level lumbar anesthesia. Key words：Adrenaline；Bupivacaine ；lumbar anesthesia 在临床麻醉中蛛网膜下腔阻滞以其操作简便，诱导快捷，效果确切等优点而使用频繁[1]，但其对机体血流动力学的干扰以及作用时效的束缚使其应用范围受到一定限制[2]。肾上腺素在腰麻中虽有应用但意见不一[3,4]，经计算机检索亦未见有系统报道[5]。为此本研究拟通过对肾上腺素在不同平面布比卡因腰麻中各项指标的观察，以期为临床腰麻时的生理稳定，拓展腰麻应用范围提供参考依据。 临床资料 85例接受下肢或下腹部手术患者，ASA I~II级，其中男55例，女30例，年龄16~55（37±8）岁，体重40~78（57±7）公斤。随机分为四组：肾上腺素组A（下腹部手术