罗哌卡因腰椎-硬膜外联合麻醉用于剖宫产术的临床观察

    Clinical effect of ropivacaine on combined spinal epidural anesthesia in cesarean section

    • 摘要: 目的:研究罗哌卡因重比重配制液腰椎-硬膜外联合麻醉用于剖宫产手术的可行性、安全性和有效性。方法:将在腰椎-硬膜外联合麻醉剖宫产术中60例初产妇,随机双盲分为R组和B组,R组用0.75%罗哌卡因2 ml加入10%葡萄糖1 ml,B组用0.75%布比卡因2 ml加入10%葡萄糖1 ml,L2~3间隙穿刺成功后以25 s速度蛛网膜下腔注药2.5~3.0 ml,硬膜外置管3.5 cm后取平卧,左倾15°。比较2组的感觉、运动阻滞的起效时间,最高阻滞平面及感觉、运动阻滞恢复时间,评估2组麻醉效果。结果:最高阻滞平面R组低于B组,从注药到最高平面阻滞时间R组明显长于B组,R组感觉和运动神经阻滞起效时间亦长于B组,下肢运动神经阻滞程度、Bromage评分R组低于B组(P<0.05~P<0.01),运动阻滞恢复时间R组短于B组(P<0.05~P<0.01),感觉阻滞恢复时间,新生儿Apgar评分及血氧饱和度(SpO2)2组差异无统计学意义(P>0.05)。结论:重比重罗哌卡因腰椎-硬膜外联合麻醉用于剖宫产术是安全有效的。

       

      Abstract: Objective:To compare the feasibility,safety and efficacy of hyperbaric ropivacaine in combined spinal epidural anesthesia (CSEA) for cesarean section.Methods:In a randomized double-blind investigation,sixty primiparas undergoing elective cesarean section delivery CSEA were enrolled.The parturients were randomly divided into:group R and group B,30 cases in each.The parturients in group R were administered with 0.75% ropivacaine 2 ml diluted with 10% glucose 1 ml;others in group B were administered with 0.75% bupivacaine 2 ml diluted with 10% glucose 1 ml.After spinal punctured at the L2~3 vertebral interspace,2.5-3.0 ml hyperbaric mixture was given intrathecally within 25 s,followed by insertion of an epidural catheter about 3.5 cm.Then patients were lay flat,turned on to the left lateral position about 15 degree.The sensory,motor block onset time,maximum sensory block level and motor block recovery times in the two groups were compared and thet wo anesthetic effects were evaluated.Results:In group R,the maximum block plane was lower than in group B,while the time of getting to the highest block levels after medicine injection was longer than in group B.The onset time of sensory and motor block in group R was significantly longer than in group B,but the duration time was shorter.In group R,the degree of low limbs motor nerves block assessed by modified Bromage Score was lower than in group B,whereas the motor block recovery time was shorter (P<0.05-P<0.01).There were no statistical differences in the sensony block recovery time Apgar scores and SpO2 of neonates between the two groups (P>0.05).Conclusions:The hyperbaric ropivacaine is an effective and safe drug in CSEA for cesarean section.

       

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