罗哌卡因与左旋布比卡因用于剖宫产手术腰硬联合麻醉的临床效果

Clinical Analysis of Ropivacaine and Levobupivacaine for Combined Spinal and Epidural Anesthesia in Caesarean Section

【目的】探讨罗哌卡因与左旋布比卡因在剖宫产手术腰硬联合麻醉(CSEA)中的临床效果。【方法】剖宫产手术患者60例随机分为两组,各30例。两组均给予CSEA,对照组采用左旋布比卡因麻醉,观察组采用罗哦卡因麻醉,比较两组麻醉效果、术中血流动力学及药物不良反应发生率。【结果】观察组感觉阻滞起效时间、运动阻滞起效时间,长于对照组(P<0.05);观察组感觉阻滞持续、术后运动恢复时间及Bromege评分均短(低)于对照组(P<0.05);两组感觉阻滞起效时(T1)、感觉最大阻滞后(T2)及感觉恢复后(T?)SBP、DBP及HR水平相比较差异均无显著性(P>0.05);两组T1、T2及T,时SBP、DBP及HR水平均低于T。时(P<0.05);观察组麻醉后头痛、恶心呕吐、腹泻、低血压、呼吸抑制发生率均低于对照组(P<0.05)。【结论】罗哌卡因与左旋布比卡因用于剖宫产手术CSEA中均能取得良好的麻醉效果,但是罗哌卡因对患者血流动力学影响较小,药物不良反应发生率较低,值得推广应用。

[Objective] To investigate the clinical effects of ropivacaine and levobupivacaine in combined spinal and epidural anesthesia(CSEA)for caesarean section.[Methods]A total of 60 patients with cesarean section were randomly divided into two groups:the control group and the observation group(n=30 in each group).All patients received CSEA.The control group was anesthetized with levobupivacaine,while the observation group was anesthetized with ropivacaine.The anesthetic effect,intraoperative hemodynamics and adverse drug reaction rate were compared between the two groups.[Results]The onset time of sensory block and the onset time of motor block were longer in the observation group than in the control group(P<0.05).The sensory block duration,postoperative exercise recovery time and Bromege score in the observation group were all shorter(lower)in the control group.There were no significant differences in the levels of SBP,DBP and HR between two group at the time points of T,(onset of sensory blockage),T2(maximum sensory blockage)and Ta(sensory recovery)(P>0.05).SBP,DBP and HR of two groups at Ti,Ta and Ta were lower than those at To(P<0.05).The incidence of headache,nausea and vomiting,diarrhea,hypotension and respiratory depression were significantly lower in the observation group than in the control group(P<0.05).[Conclusion]Ropivacaine and levobupivacaine both can achieve good anesthesia in CSEA for caesarean section.However,ropivacaine has less effect on hemodynamics and the incidence of adverse drug reactions is low,and it is worth promoting.