小剂量等比重罗哌卡因蛛网膜下腔-硬脊膜外麻醉对剖宫产母婴RAAS系统及并发症的影响

Low dose isobaric ropivacaine subarachnoid-epidural anesthesia for cesarean section The influence of RAAS system and its complications in parturients and mothers.

目的 探讨小剂量等比重罗哌卡因蛛网膜下腔-硬脊膜外麻醉对剖宫产母婴RAAS系统及并发症的影响.方法 回顾性分析408例行蛛网膜下腔-硬脊膜外麻醉剖宫产术孕妇的临床资料,根据术前麻醉使用不同剂量罗哌卡因分为常规组(204例)和小剂量组(204例),比较两组麻醉效果,检测母体及胎儿血清肾素活性(PRA)、血管紧张素Ⅱ(AT-II)和醛固酮浓度(ACD)及术后并发症.结果 两组无麻醉失败病例,小剂量组6例和常规组4例,手术时切口上端有痛感,均经硬膜外追加2 %利多卡因4ml.与T0比较,两组产妇T1~T3时间点的PRA、AT-II、ACD水平均显著下降,其中小剂量组PRA水平明显低于常规组(P<0.05),而AT-II、ACD水平两组比较差异无统计学意义(P>0.05),同时两组胎儿脐静脉血和脐动脉血PRA、AT-II、ACD水平比较,差异无统计学意义(P>0.05).两组产妇术后均出现低血压、恶心呕吐、心率异常等并发症,但常规组并发症发生率明显高于小剂量组(P<0.05).结论 小剂量等比重罗哌卡因蛛网膜下腔-硬脊膜外麻醉效果与常规组相当,但小剂量等比重罗哌卡因麻醉更有利于母婴RAAS系统的稳定,减少产妇术后并发症的发生.

Objective To investigate the effect of low-dose ropivacaine combined with spinal anesthesia on RAAS system and complications of cesarean section. Methods From September 2015 to June 2017,408 cases gravity of combined spinal-epidural anesthesia on cesarean section were retrospectively analyzed in our hospital. According to preoperative anesthesia,different doses of ropivacaine were divided into two groups:routine group (n=204) and low dose group(n=204). The effects of anesthesia were compared,and the serum renin activity,angiotensin II and aldosterone concentrations in maternal and fetal serum were measured. Results There were no anesthesia failure cases in two groups. 6 cases of weight low dose group and 4 cases of routine group had pain at the upper end of the incision,all of which received epidural administration of 2 % lidocaine 4ml. The others patients had good block effect and no obvious discomfort during operation. Compared with T0,the levels of PRA,AT-II and ACD in both groups decreased significantly at T1,T2,T3. The level of PRA in low dose group was significantly lower than that of routine group(P<0.05), there was no significant difference between the level of AT-II,ACD in two groups(P>0.05). At the same time,there were no significant difference between the two groups in the levels of PRA,AT-IIand ACD in fetal umbilical vein blood and umbilical artery blood(P>0.05). Complications such as hypotension,malignant vomiting and abnormal heart rate occurred in both groups after operation,but the incidence of complication in routine group was significantly higher than that of low dose group(P<0.05). Conclusion The effect of low-dose ropivacaine combined with spinal and epidural anesthesia is comparable to that of the conventional group,but low-dose ropivacaine anesthesia is more conducive to the stability of the maternal-infant RAAS system and reduce the postoperative complications of maternal.