国产氯普鲁卡因成功用于蛛网膜下腔麻醉剖析.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?.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?.60Tmin, 68.63?3.22vmin and 77.50?6.97 min, 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