Effect Of Hemodynamics Undergoing Csea With Different Concentration Of Bupivacaine In Caes Arean Sections

ObjectiveTo compare the anesthesia efficacy of different doses of 0.75% bupivacaine in combined spinal epidural for cesarean section. Observing the change of hemodynamic and the effect of fetal umbilical cord blood pH value. Explore an ideal dosage.MethodsSeventy-five patients(ASA I-1I)who agreed to receive combined spinal epidural and ICG monitoring system, aged 25-35 years old, weight60-75kg were randomly assigned to five groups:GroupA bupivacaine6mg, GroupB bupivacaine7mg, GroupC bupivacaine8mg, GroupD bupivacaine9mg, GroupE bupivacaine10mg. All patients were separately received 1.2ml,1.4ml,1.7ml,1.8ml,2.0ml of 0.75% isotonic specific gravity bupivacaine.Observe the changes of hemodynamic with all patients. The heart rate (HR), systolic blood pressure and diastolic blood pressure (SBP) (DBP), cardiac output (CO), cardiac index (CI), cardiac output (SV), peripheral vascular resistance (SVR) were recorded before (T1) anesthesia and postanesthetic time interval. Record the use and times of drug dosage, the time of feel block plane and cutting skin, Bromage, fetal blood gas analysis, Apgar score and the satisfaction of anaesthetic effect. Side effects such as nausea, vomiting, panting and traction reflex of the gravide were also recorded. Headache, temporary waist hemp nerve syndrome and the cauda equina syndrome were observed after operation.Result1.The comparision of SBP,DBP,HR,CO,CI,SV,SVR. The effect of hemodynamics in group D, E were higher than that in group A, B, C(P<0.05). There was no significant difference in group A, B,C(P >0.05) and in group D, E(P>0.05).2. The comparision of feel block plane, cutting skin and Bromage.(1) feel block plane:GroupA, B, C were lower than GroupD, E (P<0.05). There was no significant difference with it. (AvsB, DvsE, P>0.05). GroupA, B were lower than GroupC (P<0.05). (2) cutting skin:GroupA, B, C were longer than GroupD, E (P<0.05). There was no significant difference in group A, B, CThere was no significant difference with it amongand in group D, E(P>0.05).(3)Bromage:There was statistical significance with it (A, BvsC, D, E;CvsD, E P<0.05). There was no significant difference with it(AvsB, DvsE, P> 0.05).3.The comparision of the satisfaction of anaesthetic effect:GroupA,B were lower than GroupC, D, E(P＜0.05). There was no significant difference with it among A, BandC, D, E(P>0.05).4. The comparision of fetal umbilical cord blood pH value and Apgar score:(1)Fetal umbilical cord blood pH value:GroupA, B, C were higher than GroupD, E(P<0.05). There was no significant difference with it amongA, B, C and D, E(P>0.05).(2)Apgar score:There was no significant difference with it amongA, B,C, D, E(P>0.05). And the scores were above eight.5.The comparision of dosage of ephedrine: GroupD, E were higher than GroupA, B, C(P<0.05). There was no significant difference with it amongA, B, C and D, E(P>0.05).6.The comparision of side effects: GroupD, E were higher than GroupA, B, C with nausea (P<0.05). GroupA, B were higher than GroupC, D, E with traction reflex of the gravide(P<0.05). There was no significant difference with vomiting among A, B, C, D, E(P> 0.05).7. There were no headache, temporary waist hemp nerve syndrome and cauda equina syndrome occurred.Conclusion0.5%bupivacaine8mg is reliable and effective-dose to be used in cesarean section with combined spinal epidural anesthesia, and is highly recommended.