不同容量的硬膜外容量扩张对腰硬联合麻醉下剖宫产产妇的影响

目的 探讨不同容量的硬膜外容量扩张对腰硬联合麻醉下剖宫产产妇的影响。方法 择期行剖宫产术孕妇80例，行腰硬联合麻醉，鞘内给予0.5%等比重布比卡因11 mg，根据随机分组情况经硬膜外导管以0.5 mL/s的速度分别推入生理盐水0 mL（对照组）、5 mL、10 mL和15 mL（每组20例）。记录各组最高感觉阻滞平面的高度、感觉阻滞到达T6平面所需的时间、到达最大运动阻滞所需的时间、感觉阻滞平面回退至T10平面以及运动阻滞恢复至改良Bromage评分0分所需的时间。记录各组去氧肾上腺素的用量、恶心呕吐的发生及格拉司琼的用量。结果 10 mL组、15 mL组显著提升最高感觉阻滞平面并且缩短到达T6平面所需的时间（ P<0.05）。感觉阻滞平面回退至T10平面所需的时间各组相比差异无统计学意义（ P>0.05）。与对照组相比，不同容量的硬膜外容量扩张都能缩短到达最大运动阻滞所需的时间及运动阻滞恢复至改良Bromage 评分0分所需的时间（ P<0.05）。15 mL组去氧肾上腺素的用量大于0 mL和5 mL组（ P<0.05）。恶心、呕吐的发生及格拉司琼用量各组相当（ P>0.05)。 结论 腰硬联合麻醉下剖宫产术鞘内给予0.5%等比重布比卡因11 mg时复合10 mL生理盐水的硬膜外容量扩张是比较理想的容量。
Objective To evaluate the blocking characteristics of epidural volume extension on combined spinal-anesthesia of parturients undergoing cesarean delivery. Methods Eighty parturients were randomly allocated to one of four groups, receiving 0, 5, 10 or 15 mL normal saline, respectively, through epidural catheter at a rate of 0.5 mL/s (n=20 in each group) after combined spinal-anesthesia with 11 mg intrathecally isobaric bupivacaine. Peak sensory block height, time for sensory block to sixth thoracicdermatome level, time for highest modified Bromage motor score, time for sensory regression to tenth thoracicdermatome level, and motor block recovery to Modified Bromage 0 were recorded. Results The groups with 10 mL and 15 mL epidural extension had a higher level of peak sensory and shorter time for the sensory block to sixth thoracicdermatome level compared with the control group ( P<0.05). There were no significant group differences in the time for sensory regression to tenth thoracicdermatome level ( P>0.05). The saline epidural extension groups had significant shorter time for highest modified Bromage motor score and motor block recovery to Modified Bromage 0 compared with the control group ( P<0.05). The use of phenylephrine was significantly higher in the 15 mL treatment group ( P<0.05). Conclusion 10 mL of epidural saline volume extension is optimal for combined spinal-epidural anaesthesia of parturients undergoing caesarean delivery.