中国医药指南
中國醫藥指南
중국의약지남
CHINA MEDICINE GUIDE
2015年
24期
9-11
,共3页
新斯的明%布比卡因%左旋布比卡因%硬膜外镇痛%经腹卵巢手术
新斯的明%佈比卡因%左鏇佈比卡因%硬膜外鎮痛%經腹卵巢手術
신사적명%포비잡인%좌선포비잡인%경막외진통%경복란소수술
Neostigmine%Bubivacaine%Levobupivacaine%Epidural analgesia%Transabdominal ovarian operation
目的：比较腰硬联合与硬膜外经腹卵巢手术麻醉和左旋布比卡因与布比卡因复合新斯的明术后镇痛效果。方法60例卵巢手术患者，年龄16~48岁，体质量47~83kg，ASAⅠ~Ⅱ级，随机分成A、B两组各30例。L2~3硬膜外穿刺成功，A组注入0.75%布比卡因4mL， B组注入1%利多卡因4mL，各加入20μg肾上腺素作为实验量，B组用腰穿针顺硬膜外穿刺针入蛛网膜下腔，注入布比卡因15mg，然后各向头端置入硬膜外导管4cm，A组硬膜外注入局麻混合液初量，A、B组术中酌情注入追加量，维持阻滞平面。观察比较两组局麻药用量、血液动力学变化、感觉、运动阻滞和不良反应以及术后当VAS评分≥3分，硬膜外注入A组：布比卡因15mg或B组：左旋布比卡因15mg各复合新斯的明2μg/kg。术后记录活动时镇痛强度、镇痛时间和不良反应。结果硬膜外预注0.75%布比卡因4mL再置入硬膜外导管注入局麻药有血液动力学变化较轻（P<0.05）和不良反应轻，两组感觉和运动阻滞皆较完善，肌松满意。术后VAS评分相比无显著差异（P＞0.05）；注药后痛觉比较明显（VAS评分≥3分）时间：A组（711±128）min、B组（743±143）min（P＞0.05）。结论置管前注入0.75%布比卡因4mL硬膜外阻滞卵巢手术的麻醉血液动力学较稳定，不良反应轻，安全有效并能达到腰麻较完善的麻醉效果。两组复合新斯的明有明显镇痛作用而无明显不良反应。
目的：比較腰硬聯閤與硬膜外經腹卵巢手術痳醉和左鏇佈比卡因與佈比卡因複閤新斯的明術後鎮痛效果。方法60例卵巢手術患者，年齡16~48歲，體質量47~83kg，ASAⅠ~Ⅱ級，隨機分成A、B兩組各30例。L2~3硬膜外穿刺成功，A組註入0.75%佈比卡因4mL， B組註入1%利多卡因4mL，各加入20μg腎上腺素作為實驗量，B組用腰穿針順硬膜外穿刺針入蛛網膜下腔，註入佈比卡因15mg，然後各嚮頭耑置入硬膜外導管4cm，A組硬膜外註入跼痳混閤液初量，A、B組術中酌情註入追加量，維持阻滯平麵。觀察比較兩組跼痳藥用量、血液動力學變化、感覺、運動阻滯和不良反應以及術後噹VAS評分≥3分，硬膜外註入A組：佈比卡因15mg或B組：左鏇佈比卡因15mg各複閤新斯的明2μg/kg。術後記錄活動時鎮痛彊度、鎮痛時間和不良反應。結果硬膜外預註0.75%佈比卡因4mL再置入硬膜外導管註入跼痳藥有血液動力學變化較輕（P<0.05）和不良反應輕，兩組感覺和運動阻滯皆較完善，肌鬆滿意。術後VAS評分相比無顯著差異（P＞0.05）；註藥後痛覺比較明顯（VAS評分≥3分）時間：A組（711±128）min、B組（743±143）min（P＞0.05）。結論置管前註入0.75%佈比卡因4mL硬膜外阻滯卵巢手術的痳醉血液動力學較穩定，不良反應輕，安全有效併能達到腰痳較完善的痳醉效果。兩組複閤新斯的明有明顯鎮痛作用而無明顯不良反應。
목적：비교요경연합여경막외경복란소수술마취화좌선포비잡인여포비잡인복합신사적명술후진통효과。방법60례란소수술환자，년령16~48세，체질량47~83kg，ASAⅠ~Ⅱ급，수궤분성A、B량조각30례。L2~3경막외천자성공，A조주입0.75%포비잡인4mL， B조주입1%리다잡인4mL，각가입20μg신상선소작위실험량，B조용요천침순경막외천자침입주망막하강，주입포비잡인15mg，연후각향두단치입경막외도관4cm，A조경막외주입국마혼합액초량，A、B조술중작정주입추가량，유지조체평면。관찰비교량조국마약용량、혈액동역학변화、감각、운동조체화불량반응이급술후당VAS평분≥3분，경막외주입A조：포비잡인15mg혹B조：좌선포비잡인15mg각복합신사적명2μg/kg。술후기록활동시진통강도、진통시간화불량반응。결과경막외예주0.75%포비잡인4mL재치입경막외도관주입국마약유혈액동역학변화교경（P<0.05）화불량반응경，량조감각화운동조체개교완선，기송만의。술후VAS평분상비무현저차이（P＞0.05）；주약후통각비교명현（VAS평분≥3분）시간：A조（711±128）min、B조（743±143）min（P＞0.05）。결론치관전주입0.75%포비잡인4mL경막외조체란소수술적마취혈액동역학교은정，불량반응경，안전유효병능체도요마교완선적마취효과。량조복합신사적명유명현진통작용이무명현불량반응。
Objective Comparison of combined spinal epidural anesthesia(CSEA)and epidural anesthesia in transabdominal ovarian operation and postoperative analgesic effect of levobupivacaine and bupivacaine compound neostigmine. Methods Sixty patients, ASA classⅠ~Ⅱ, aged 16-48 yr, weighed 47-83 kg, undergoing transabdominal ovarian operation, were randomly divided into A(n=30)and B(n=30)groups. The lumber puncture was performed at the L2~3 interspace, 0.75%bupivacaine 4 mL or 1%lidocaine 4 mL plus 20μg epinephrine in A or B group as a"test dose"was injected prior to epidural insertion, subarachnoid injection of bupivacaine 15 mg in B group, the catheter was inserted upward 4 cm, the patients would receive local anesthetic mixture as the initial volume in A group. The anesthesia was maintained with epidural administration. The local anesthetic, blood pressure and heart rate, the spread level of analgesic and motor block, adverse events were observed and compared. While the VAS score was more than 3 cm after operation, the patients were received epidural bupivacaine as A group or levobupivacaine 15 mg as B group plus neostigmine 2μg/kg. Results The epidural anesthesia of a prior injection of 0.75%bupivacaine 4 mL had less change of blood pressure and heart rate(P<0.05), as better motor block and muscle relaxation as spinal anesthesia’s and fewer adverse events. Postoperative VAS score:the two groups had no signiifcant difference (P>0.05);after the epidural injection pain is obvious (VAS score≥3 cm):A group(711±128)min, B group (743±143) min(P>0.05). Conclusion A prior epidural injection of 0.75%bupivacaine 4 mL has less hemodynamics change and is safe and as effective as spinal anesthesia’s for the anesthesia in transabdominal ovarian operation. Postoperative epidural neostigmine coadministered with bupivacaine or levobupivacaine has obvious pain relief without increasing the incidence of adverse effects.
