CAJ | 학술논문

目的：探讨左布比卡因腰硬联合麻醉用于剖宫产的最佳剂量。方法选择足月初产妇行剖宫产手术患者160例随机分为四组，分别给予等比重0.5%左布比卡因1 ml复合硬膜外2%利多卡因3 ml（A组）、等比重0.5%左布比卡因1.5 ml（B组）、2 ml（C组）、2.5 ml（D组）进行腰硬联合麻醉，每组40例。术中连续监测生命体征并记录麻醉前（T0）及麻醉后1 min（T1）、5 min（T2）、10 min（T3）、15 min（T4）、30 min（T5）的收缩压（SBP）、舒张压（DBP）、心率（HR）、血氧饱和度（SpO2）值；观察并记录给药后的麻醉效应，并发症的发生率及新生儿Apgar评分情况。结果痛觉消失时间、痛觉恢复时间和运动阻滞恢复时间B、C、D组与A组分别比较均有统计学差异（P＜0.05）。与T0时比较，B组平均动脉压（MAP）在T2、T3时，C、D组HR、MAP在T1、T2、T3、T4时均降低（P＜0.05）。与A组比较，B组MAP在T2、T3时，C、D组MAP、HR在T1、T2、T3、T4时均降低（P＜0.05）。术中四组产妇的SpO2除D组在T2、T3时有所降低外，均维持在98%以上，四组新生儿出生后各时间点Apgar评分均＞8分。A组与B、C、D组比较，患者术中低血压、恶心呕吐、呼吸抑制、追加2%利多卡因例数、麻黄碱用量差异有统计学意义（P＜0.05）。结论剖宫产手术行0.5%左布比卡因1.0 ml蛛网膜下腔阻滞复合硬膜外追加2%利多卡因3 ml对剖宫产患者循环影响最小，并能最大限度减少不良反应的发生。
목적：탐토좌포비잡인요경연합마취용우부궁산적최가제량。방법선택족월초산부행부궁산수술환자160례수궤분위사조，분별급여등비중0.5%좌포비잡인1 ml복합경막외2%리다잡인3 ml（A조）、등비중0.5%좌포비잡인1.5 ml（B조）、2 ml（C조）、2.5 ml（D조）진행요경연합마취，매조40례。술중련속감측생명체정병기록마취전（T0）급마취후1 min（T1）、5 min（T2）、10 min（T3）、15 min（T4）、30 min（T5）적수축압（SBP）、서장압（DBP）、심솔（HR）、혈양포화도（SpO2）치；관찰병기록급약후적마취효응，병발증적발생솔급신생인Apgar평분정황。결과통각소실시간、통각회복시간화운동조체회복시간B、C、D조여A조분별비교균유통계학차이（P＜0.05）。여T0시비교，B조평균동맥압（MAP）재T2、T3시，C、D조HR、MAP재T1、T2、T3、T4시균강저（P＜0.05）。여A조비교，B조MAP재T2、T3시，C、D조MAP、HR재T1、T2、T3、T4시균강저（P＜0.05）。술중사조산부적SpO2제D조재T2、T3시유소강저외，균유지재98%이상，사조신생인출생후각시간점Apgar평분균＞8분。A조여B、C、D조비교，환자술중저혈압、악심구토、호흡억제、추가2%리다잡인례수、마황감용량차이유통계학의의（P＜0.05）。결론부궁산수술행0.5%좌포비잡인1.0 ml주망막하강조체복합경막외추가2%리다잡인3 ml대부궁산환자순배영향최소，병능최대한도감소불량반응적발생。
Objective To investigate the optimal dose of levobupivacaine in combined spinal epidural anesthesia for caesarean section. Methods 160 patients of full-term primipara undergoing cesarean section were randomly divided into 4 groups(n=40 for each group). They were given 0.5%isobaric levobupivacaine 1 ml in spinal and 2% epidural lidocaine 3 ml (group A), 0.5% isobaric levobupivacaine 1.5 ml (group B), 2 ml (group C), 2.5 ml (group D) for combined spinal epidural anesthesia. SBP, DBP, HR and SpO2 were monitored before anesthesia (T0) and 1, 5, 10, 15 30 min after anesthesia (T1-5), and the drug effect after anesthesia, incidence rate of complications, and Apgar score were all observed. Results The pain disappearance time, pain recovery time and motor block recovery time had significant differences among groups A, B, C and D, especially in group A (P<0.05). To compare with baseline, MAP in group B 5, 10 min after anesthesia, HR, MAP in groups C and D 1, 5, 10, 15 min after anesthesia decreased significantly (P<0.05). MAP, HR in group B, C and D were lower significantly than those in group A 1, 5, 10, 15 min after anesthesia (P<0.05). In addition to group D patients with lower SpO2 5, 10 min after anesthesia(P<0.05), it was maintained at more than 98%. Apgar scores of 4 groups were 8 points 1, 5, 10 min after birth, there was no significant difference. Intraoperative hypotension, nausea and vomiting, respiratory depression and dose of ephedrine in group B, C and D had a high incidence, there was a significant difference than group A (P<0.05). Dosage of additional use of epidural 2% lidocaine in group A was more than other groups. (P<0.05). Conclusion 0.5%levobupivacaine 5 mg spinal anesthesia combined an additional 2%lidocaine 3 ml epidural anesthesia for the caesarean section can provide reliable anesthesia and has the minimal effect on maternal hemodynamics .