中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2008年
8期
740-742
,共3页
麻醉,硬膜外%剖宫产术%胎盘%左旋布比卡因
痳醉,硬膜外%剖宮產術%胎盤%左鏇佈比卡因
마취,경막외%부궁산술%태반%좌선포비잡인
Anesthesia,epidural%Cesarean section%Placenta%Levobupivacaine
目的 评价剖宫产术病人硬膜外左旋布比卡因的胎盘转移情况.方法 择期硬膜外麻醉下剖宫产术病人60例.于L1,2或L2,3间隙进行硬膜外穿刺,穿刺成功后注射0.5%左旋布比卡因5ml(含1:20万肾上腺素)试验剂量,5 min后无脊麻征象后,追加9～12 ml,5 min后再追加1次.娩出时抽取脐动脉血样,进行血气分析;于娩出后l、5min行Apgar评分.选择30例病人,娩出时抽取母体静脉血样和脐静脉血样,采用高效液相色谱法测定血浆左旋布比卡因浓度.结果 在硬膜外注药结束后10～22 min60例胎儿娩出,新生儿Apgar评分均≥7分,脐动脉血Ph值均≥7.25.娩出时母体静脉血与脐静脉血血浆左旋布比卡因浓度分别为0.35 ±0.24、(0.24±0.21)μg/ml,脐静脉血与母体静脉血血浆左旋布比卡因浓度的比值为0.7 ±0.3.结论 宫产术病人硬膜外左旋布比卡因可通过胎盘,脐静脉血与母体静脉血左旋布比卡因浓度的比值为0.7.
目的 評價剖宮產術病人硬膜外左鏇佈比卡因的胎盤轉移情況.方法 擇期硬膜外痳醉下剖宮產術病人60例.于L1,2或L2,3間隙進行硬膜外穿刺,穿刺成功後註射0.5%左鏇佈比卡因5ml(含1:20萬腎上腺素)試驗劑量,5 min後無脊痳徵象後,追加9～12 ml,5 min後再追加1次.娩齣時抽取臍動脈血樣,進行血氣分析;于娩齣後l、5min行Apgar評分.選擇30例病人,娩齣時抽取母體靜脈血樣和臍靜脈血樣,採用高效液相色譜法測定血漿左鏇佈比卡因濃度.結果 在硬膜外註藥結束後10～22 min60例胎兒娩齣,新生兒Apgar評分均≥7分,臍動脈血Ph值均≥7.25.娩齣時母體靜脈血與臍靜脈血血漿左鏇佈比卡因濃度分彆為0.35 ±0.24、(0.24±0.21)μg/ml,臍靜脈血與母體靜脈血血漿左鏇佈比卡因濃度的比值為0.7 ±0.3.結論 宮產術病人硬膜外左鏇佈比卡因可通過胎盤,臍靜脈血與母體靜脈血左鏇佈比卡因濃度的比值為0.7.
목적 평개부궁산술병인경막외좌선포비잡인적태반전이정황.방법 택기경막외마취하부궁산술병인60례.우L1,2혹L2,3간극진행경막외천자,천자성공후주사0.5%좌선포비잡인5ml(함1:20만신상선소)시험제량,5 min후무척마정상후,추가9～12 ml,5 min후재추가1차.면출시추취제동맥혈양,진행혈기분석;우면출후l、5min행Apgar평분.선택30례병인,면출시추취모체정맥혈양화제정맥혈양,채용고효액상색보법측정혈장좌선포비잡인농도.결과 재경막외주약결속후10～22 min60례태인면출,신생인Apgar평분균≥7분,제동맥혈Ph치균≥7.25.면출시모체정맥혈여제정맥혈혈장좌선포비잡인농도분별위0.35 ±0.24、(0.24±0.21)μg/ml,제정맥혈여모체정맥혈혈장좌선포비잡인농도적비치위0.7 ±0.3.결론 궁산술병인경막외좌선포비잡인가통과태반,제정맥혈여모체정맥혈좌선포비잡인농도적비치위0.7.
Objective To determine the placental transfer of epidural levobupivacaine for cesarean section. Methods Sixty parturients (ASA ⅠorⅡ) aged 24-35 yr weighing 60-80 kg undergoing elective cesarean section under epidural anesthesia were studied. Epidural anesthesia was performed at L1,2 or L1,3 interspace. The catheter was advanced 3 cm cephalad into the epidural space. A test dose of 0.5% levobupivacaine 5 ml with 1:200 000 epinephrine was injected. If there were no signs of subarachnoid injection in 5 min, 9-12 ml of 0.5% levobupivacaine was administered twice at 5 min interval. Arterial blood samples were taken from the double- clamped umbilical cord segment at delivery for determination of blood pH. Apgar scores at 1 and 5 min after birth were recorded. Blood samples were taken from maternal and umbilical vein for determination of plasma levobupivacaine concentration by high performance liquid chromatography ( HPLC). Results The pH of the umbilical arterial blood was ≥ 7.25. The Apgar scores at 1 and 5 min after birth were ≥ 7.0. The levobupivacaine concentration of maternal and umbilical venous blood was 0.35±0.24 and (0.24 ±0.21) μg/ml respectively at the time of delivery. The ratio of umbilical and maternal venous blood levobupivacaine concentration was 0.7 ± 0.3. Conclusion Epidural levobupivacaine can cross the placenta during cesarean section. The ratio of umbilical and maternal venous blood levobupivacaine concentration is 0.7.
