国产氯普鲁卡因成功的用于蛛网膜下腔麻醉.docVIP

国产氯普鲁卡因成功用于蛛网膜下腔麻醉 傅润乔 赵宏利 薛绵荣 王大伟 徐 伟 阎红林 张晓红 金运敏 司 满 李树林 作者单位：同济大学北京微创医院（筹），北京市垂杨柳医院麻醉医学中心 [摘要] 目的 研究国产氯普鲁卡因腰麻的可行性和安全性。方法40例产妇经L2-3脊间隙行腰麻-硬膜外联合穿刺，向蛛网膜下间隙注入（针斜面向尾）氯普鲁卡因合剂（2.5%氯普鲁卡因1.2ml+10%葡萄糖0.5ml+3%麻黄碱0.5ml） 2.2ml/30~40秒。结果 (1) 麻醉起效时间、胸11无痛时间、双下肢不能抬起时间、达到最高阻滞平面的时间，分别为22.78±9.52sec，3.65±0.86min，3.67±0.73min和8.04±1.11min; 最高阻滞平面为胸4.05±1.38；麻醉消退至胸11开始疼痛时间、双下肢能抬起时间、麻醉完全消失时间，分别为54.75±8.60min, 68.63±13.22min和77.50±16.97min。(2) 术中无产妇诉疼痛, 术者感觉腹肌非常松弛。 (3) 麻醉后出现低血压反应17例（42.5%），平均出现时间5.21±1.67min; 单例最大降压幅度SP、DP、MAP分别为53%、63%、54%，均给予麻黄碱15mg好转。心率相对稳定。SpO2正常。(4) 麻醉后恶心22例（55%），其中12例（30%）发生在切开子宫前，与低血压有关，其他与手术操作有关；呕吐16例（40%），娩胎前5例，娩胎后11例。(5) 麻醉后及其1个月内未见任何精神神经系统不良反应。(6) 2.5%氯普鲁卡因pH和比重分别为6.38±0.55，比重为1.012±0.003，其腰麻合剂pH和比重分别为6.12±0.46，比重为1.012±0.003。结论 国产盐酸氯普鲁卡因可安全有效的用于腰麻，其pH和比重分别为6.38±0.55和1.012±0.003，大于文献所示pH为3~4。 [关键词] 氯普鲁卡因；腰麻 Chloroprocaine use successfully for spinal anesthesia. Fu Run-qiao, Zhao Hong-li, Xue Mian-rong, et al. Center of Anesthesiology, Chui Yang-liu Hospital, Beijing 100022 [ABSTRACT] Objective To study possibility and safety of domestic chloroprocaine use for spinal anesthesia. Method 40 primiparas were punctured from lumbar 2~3 spinal interspace and injected a 2.2ml mixture (2.5% chloroprocaine 1.2ml, 10% glucose 0.5ml, 3% ephedrine 0.5ml) within 30~40 seconds into subarachnoid space. Results (1) Onset time, thoracic 11 pain-free time, time of lower limbs were unable to lift up, time of reaching to the highest nerve block level were, 22.78±9.52sec，3.65±0.86min，3.67±0.73min and 8.04±1.11min, respectively. The highest nerve block mean level were thoracic 4.05±1.38. Time of nerve block fade to thoracic 11, time of lower limbs were able to lift up and time of anesthesia complete disappearance were, 54.75±8.60min, 68.63±13.22min and 77.50±16.97min, respectively. (2) No one of primiparas complained surgery pain, and primiparas’ abdominal muscles were high relaxation. (3) Hypotensions occur at mean time 5.21±1.67min in 17 cases (17%) after anesth