罗哌卡因对腰硬联合麻醉剖宫产患者术中循环状态、血清皮质醇水平及母婴结局的影响

Effect of Ropivacaine on Intraoperative Circulation States, Serum Cortisol Levels and Maternal-infant Outcomes in Patients Undergoing Cesarean Section under Combined Spinal-epidural Anesthesia

目的:探讨罗哌卡因对腰麻-硬膜外阻滞联合麻醉(CSEA)剖宫产患者术中循环状态、血清皮质醇水平及母婴结局的影响.方法:回顾性分析经罗哌卡因CSEA(研究组,n=38)与布比卡因CSEA(对照组,n=40)行剖宫产的78例单胎产妇的临床资料.比较两组麻醉前(T0)、麻醉后5 min(T1)、麻醉后10 min(T2)、胎儿娩出(T3)时产妇血流动力学指标[平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)]及血清皮质醇水平变化情况,记录产妇麻醉效果(肌松情况、感觉阻滞起效时间、运动阻滞起效时间、感觉阻滞维持时间、运动阻滞维持时间)、镇痛效果[视觉模拟评分法(VAS)]、相关麻醉并发症发生率及新生儿健康状态[阿氏评分(Apgar评分)]评估结果.结果:T1~T3时,两组MAP水平均较T0时降低,且对照组低于研究组,血清皮质醇水平较T0时升高,且对照组高于研究组,差异均具有统计学意义(P<0.05);两组产妇肌松效果良好率、感觉阻滞起效时间、运动阻滞起效时间、感觉阻滞维持时间和VAS评分结果比较,差异均无统计学意义(P>0.05);研究组运动阻滞维持时间短于对照组,差异有统计学意义(P<0.05);研究组低血压发生率低于对照组,差异有统计学意义(P<0.05);两组心动过缓、呼吸抑制、恶心呕吐、腰部酸痛、头痛等并发症发生率及新生儿Apgar评分比较,差异无统计学意义(P>0.05).结论:罗哌卡因CSEA下行剖宫产术对产妇术中循环功能及血流动力学状态的影响较小,利于改善母婴结局.

Objective:To investigate the effect of ropivacaine on intraoperative circulation states,serum cortisol levels and maternal-infant outcomes in patients undergoing cesarean section under combined spinal-epidural anesthesia(CSEA).Methods:The clinical data of 78 single-birth women who underwent cesarean section under CSEA with ropivacaine(study group,n=38)and CSEA with bupivacaine(control group,n=40)were retrospectively analyzed.The changes in the levels of maternal hemodynamic indexes[mean arterial pressure(MAP),heart rate(HR),pulse oxygen saturation(SpO2)]and serum cortisol before anesthesia(T0),at 5 minutes after anesthesia(T1),at 10 minutes after anesthesia(T2)and during fetal delivery(T3)were compared between the two groups.The anesthetic effect(muscle relaxation,onset time of sensory block,onset time of motion block,maintenance time of sensory block,maintenance time of motion block),analgesic effect[visual analogue scale(VAS)],anesthesia-related complications and health status of newborns[Apgar scores(Apgar scores)]in the women were recorded.Results:The levels of MAP at T1~T3 were lower than those at T0 in the two groups,and the levels in the control group were lower than those in the study group,while the serum level of cortisol was higher than that at T0,and the level in the control group was higher than that in the study group,with statistically significant differences(P<0.05).There were no statistically significant differences in the good rate of the muscle relaxation effect in the women,the onset time of sensory block,the onset time of motion block,the maintenance time of sensory block and VAS scores(P>0.05).The maintenance time of motion block in the study group was shorter than that in the control group,and the difference was statistically significant(P<0.05).The incidence of hypotension in the study group was lower than that in the control group,and the difference was statistically significant(P<0.05).There were no statistically significant differences in the incidence of complications such as bradycardia,respiratory depression,nausea and vomiting,lumbar pain and headache,and Apgar scores between the two groups(P>0.05).Conclusion:Ropivacaine for cesarean section under CSEA has small effect on maternal circulatory functions and hemodynamic status,which is beneficial to the improvement of maternal-infant outcomes.