0.2%罗哌卡因上胸段硬膜外麻醉有效性和安全性探讨

The Efficacy and Safety of 0.2% Ropivacaine for Upper Thoracic Epidural Anesthesia

[目的]观察0.2%罗哌卡因用于上胸段硬膜外麻醉行乳腺癌手术的有效性和安全性。[方法]ASAⅠ～Ⅱ级择期手术患者40例,T2～3或T3～4常规硬膜外穿刺向头端置管,注入1%利多卡因3～5ml为试验量,随后给0.2%罗哌卡因15～20ml,观察镇痛效果与阻滞平面范围,监测血压(BP)、心率(HR)、脉搏氧饱和度(SpO2)、心电图(ECG)、潮气量、分钟通气量、最大通气量、血气、乳酸。术毕测麻醉平面和上肢运动情况。[结果]40例患者中39例麻醉效果满意,1例因麻醉平面未能扩开而改全麻;潮气量、分钟通气量和最大通气量麻醉前后无明显改变;BP平稳,仅4例麻醉前后血压下降幅度大于25%。[结论]0.2%罗哌卡因低浓度高容积行上胸段硬膜外麻醉无痛、安全。

[Purpose] To evaluate the efficacy and safety of 0.2% Ropivacaine applied for upper thoracic epidural anesthesia during the breast cancer operation. [Methods] Forty patients with ASA Ⅰ-Ⅱ degree underwent epidural ization with 1% Lidoeaine 3-5ml at T2-3 or T3-4. as trial dose and, followed by 0.2% Ropivacaine 15-20ml infusion. The anesthesia effect and segments of block were ditermined. The blood pressure（BP）,heart rates（HR）, blood oxygen saturation（SpO2）,eletroeardiogram（ECG）, tidal volum（TV）, minute ventilation（MV）,maximal voluntary venrilation（MVV）, blood gas, lactic acid were measured. Levels of sense obstacle and movement of bilateral upper limbs were recorded after operation. [Results ] Of 40 cases with anesthesia, 39 cases was satisfactory, while 1 case was changed to general anesthesia due to the unexpansion of the blockade level. There were no significant changes in TV, MV, MVV between pre-and post-anesthesia. Bp was relatively stable with Bp decreas over 25% only in 4 cases. [Conclusions] With low concentration and high volume 0.2% Ropivacaine can be applied for upper thoracic epidural anesthesia with painlessness and safety.