目的 探讨小剂量布比卡因腰-硬联合麻醉在妇科腹腔镜手术中的临床效应.方法 妇科腹腔镜手术80例,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,按照随机对照表随机分为2组,每组40例,即A组(小剂量布比卡因腰-硬联合麻醉组,为7.5mg布比卡因+芬太尼20μg 混合液)和B组(常规剂量布比卡因腰-硬联合麻醉组,布比卡因15 mg),观察2组的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO 2)变化、肌松效果、2组最高阻滞平面到达时间、下肢运动恢复时间、不良反应(低血压、寒战、呕吐、尿管不适)发生率以及患者满意度.结果 麻醉前2组间血流动力学差异均无统计学意义,麻醉后B组低血压,寒战,恶心、呕吐和尿管不适发生率分别为22.5%、12.5%、20%和15%,均明显高于与A组(P<0.05);A组的满意度为95%,明显高于B组的77.5%(P<0.05);B组最高阻滞平面到达时间为(5.30±1.22)min,短于A组的(7.07±1.91)min(P<0.01);2组最高阻滞平面差异无统计学意义;B组的下肢运动恢复时间为(254.25±56.14)min,明显长于A组的(75.88±17.97)min(P<0.01).结论 在妇科腹腔镜手术中,小剂量布比卡因复合芬太尼腰-硬联合麻醉与常规剂量布比卡因相比,对血流动力学影响较小,不良反应较少,运动恢复较快,患者满意度较高.%Objective To evaluate clinical efficacy of low dose bupivacaine combined spinal epidural anesthesia (CSEA) in gynecologic laparoscopic surgery.Methods 80 ASAⅠ-Ⅱgynecological patients undergoing laparoscopic surgery were randomized into group A and group B (n=40 in each group).CSEA was performed at L2-3 or L3-4 with low-dose bupivacaine on group A(0.75% bupivacaine 7.5mg and fentanyl 20ug) and CSEA was performed at L2-3 or L3-4 with conventional-dose bupivacaine on group B (0.75% bupivacaine 15mg).The following were recorded, hemodynamic variables(ECG,MAP, HR, SpO2),the top blocked level, lower limbs'muscle strength, side effects and patients' satisfaction. Start effect time, degree of muscle relaxation, the times of the height of block appearance and patients' satisfaction between two groups were compared. Results Before anesthesia, there was no signiifcantly differences between two groups in the hemodynamic variables; After anesthesia, compared with those of group B, group A had fewer cases in hypotension, chill, nausea, vomiting and discomfort of urine tube(0 vs. 22.5%)0 vs.12.5%、2.5%vs.20% and 0 vs.15%) (P< 0.05); The satisfaction degree of patients in the group A is signiifcantly better than the group B(95% vs.77.5%)(P< 0.05);Time for the lower limb muscle strength return to Bromage 1 score was shorter in group A (min, 75.88±17.97 vs. 254.25±56.14)(P< 0.01); The times of the height of block appearance was longer in group A (min, 7.07±1.91 vs.5.30±1.22)(P<0.01); Top blocked level and start effect time were no signiifcantly differences between two groups.Conclusion In gynecologic laparoscopic surgery, compared with conventional-does bupivacaine, low dose bupivacaine plus fentanyl in combined spinal epidural anesthesia has fewer adverse reaction, less inlfuence on hemodynamics, earlier recovery of motion and higher satisfaction degree.
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