罗哌卡因腰麻-硬膜外联合阻滞在妊高征剖宫产术中的临床观察

CLINICAL STUDY OF COMBINED SPINAL-EPIDUAL ANESTHESIA OF ROPIVICAINE AND FENTANYL IN CAESAREAN SECTION OF PREGNANCY-INDUCED HYPERTENSION

[目的]观察小剂量罗哌卡因复合芬太尼腰麻-硬膜外联合阻滞(CSEA)在妊高征剖宫产术中应用的可行性。[方法]40例急行剖宫产的妊高征患者均行腰麻-硬膜外联合阻滞(CSEA),按腰麻使用的药物随机分成两组,R组给予0.75%罗哌卡因1.5ml,RF组给予0.75%罗哌卡因0.8ml+25μg芬太尼,两组均加10%葡萄糖配成重比重液3ml。分别予以评定麻醉效果,记录BP和HR的变化以及注射局麻药至胎儿娩出时间(I-D)、新生儿娩出1min和5min的Apgar评分。[结果]两组麻醉效果均好,感觉阻滞程度差异无显著性;RF组有2例胎儿娩出时术者称腹肌紧,但与R组比较差异无显著性;RF组麻醉后血流动力学稳定,R组有5例需用麻黄素对症处理,血压下降程度与RF组比差异有显著性;R与RF组的Ⅰ-D分别为(19.8±2.5)min和(20.2±1.8)min、Apgar评分1min分别为(7.87±0.21)和(7.77±0.32)、5min分别为8.52±1.31)和(8.33±1.09),组间比较差异无显著性。[结论]罗哌卡因复合芬太尼CSEA用于妊高征剖宫产术,能减少罗哌卡因用量,麻醉效果确切,产妇血流动力学稳定,对新生儿也无不良影响。

To evaluate the feasibility of combined spinal-epidual anesthesia （CSEA）with small-dose of ropivicaine and fentanyl in caesarean section of pregnancy-induced hypertension（PIH）.[Methods]Forty PIH patients for caesarean section were randomly divided into two groups based on drug used in spinal.0.75% ropivicaine 1.5 ml or 0.75% ropivicaine 0.8 ml combined with fentanyl 25 μg was given intrathecally in R or RF group respectively.The drugs were diluted with 10% dextrose into hyperbaric mixture at the volume of 3 ml.The effect of anesthesia,change of BP and HR were assessed;the duration between the induction of spinal and delivery（I-D） and Apgar score of the neonate 1 and 5 minute after birth were recorded.[Results]Anesthesia was very effective in all patients.There was no obvious difference in sensory block between the two groups.The cardiovascular was more stable and had obvious difference in the descending of BP between the two groups,but has no obvious difference in delivery（I-D） and Apgar score.[Conclusion]CSEA with ropivicaine and fentanyl in caesarean section of pregnancy-induced hypertension can reduce the dose of ropivicaine .The anesthesia is effective.Cardiovascular is stable to pregnant woman and no adverse effects on neonates occur.