罗哌卡因用于经腹胆囊切除术硬膜外麻醉临床效果观察

Clinical observation of ropivacaine used inepidural anesthesia for abdominal cholecystectomy

目的 观察经腹胆囊切除术行连续硬膜外麻醉中 ,7 5g/L罗哌卡因与 16g/L利多卡因和 2g/L丁卡因混合液的临床效果。方法 4 0例ASA分级Ⅰ～Ⅱ择期经腹胆囊切除术患者 ,随机、双盲分为A(7 5g/L罗哌卡因 )、B(16 0g/L利多卡因 +2 0g/L丁卡因 )两组 ,每组 2 0例。取T8～ 9硬膜外间隙穿刺 ,行连续硬膜外麻醉。使用针刺痛感评定法测定感觉神经阻滞的起效、持续和消退时间 ;记录围麻醉期中患者生命体征变化、不良反应发生率和处理情况。结果 患者心率、呼吸、脉搏氧饱和度的变化、不良反应发生率、感觉神经阻滞节段数、腹肌松弛和手术条件满意度两组差异无显著性 (P >0 0 5 )。A组诱导后 30、4 0min时血压均低于基础值(P <0 0 5 ) ,B组诱导后 15、2 0、30min时血压较基础值显著降低 (P <0 0 1)。B组收缩压在诱导后 15、2 0、30min时点显著低于A组值 ,B组舒张压在诱导后 15、2 0min时点值显著低于A组值 (P <0 0 5 )。感觉阻滞起效时间和胸段最高平面出现时间 ,B组快于A组 (P <0 0 5 ) ;总感觉阻滞持续时间 ,B组短于A组 (P <0 0 5 )。术中麻黄碱使用率 ,B组高L罗哌卡因用于硬膜外麻醉可以为经腹胆囊切除术提供满意的手术条件 ,其对术中血压的影响小于 16g/L利多卡因和 2g/L丁卡因混合液。

Objective To investigate clinical effects of 7.5 g/L ropivacaine used in thoracic epidural anesthesia and to compare it with an established local anaesthetic, 16 g/L lignocaine + 2 g/L tetracaine in the patients undergoing abdominal cholecystectomy. Methods Forty patients were randomly assigned to two groups: group A with 7.5 g/L ropivacaine, group B with 16 g/L lignocaine + 2 g/L tetracaine. Epidural anaesthesia was established by injecting 10～15 ml inductive solution through T 8～9 thoracic interspace. Sensory onset, spread and duration of anesthetics were measured using the pin prick method.Results No serious adverse events were observed in this study. Compared with 16 g/L lignocaine + 2 g/L tetracaine, 7.5 g/L ropivacaine had less effects on blood pressure and longer duration in sensory blockage. Conclusion 7.5 g/L ropivacaine is an effective and safe alternative to 16 g/L lignocaine + 2 g/L tetracaine in epidural anesthesia for abdominal cholecystectomy.