不同麻醉药物用于剖宫产腰麻-硬膜外联合麻醉临床观察

A clinical study on different anesthesia medication in combined and epidural anesthesia in caesarean section

目的：探讨罗哌卡因与布比卡因、地卡因的腰麻-硬膜外联合麻醉用于剖宫产术的安全性和有效性。方法：将90例产妇随机分为A、B、C组。用0．89％甲磺酸罗哌卡因（A组）、0．75％布比卡因（B组）和1％地卡因（C组）各1ml，分别加入10％葡萄糖1ml和3％麻黄素1ml配成重比重溶液，蛛网膜下腔注药2～3ml，术中酌情于硬膜外给予0．89％罗哌卡因或2％利多卡因5～10ml维持麻醉。观察比较3组患者在感觉、运动阻滞及恢复时间上的异同，并观察用药后的不良反应及对新生儿的影响。结果：A组患者感觉和运动的最大阻滞起效时间均较B、C组长（P〈0．05）；3组在最大感觉阻滞平面上差异无统计学意义（P〉0．05）；A组患者术后感觉恢复时间比B、C组短（P〈0．05）；A组患者最大Bromage评分多为0～1级，明显小于B、C组（P〈0．05）；最大运动阻滞时间比B、C组长（P〈0．05），而运动阻滞完全恢复时间短于B、C组（P〈0．05）；A组患者低血压、恶心、呕吐的发生率低于B、C组（P〈0．05）；新生儿Apgar评分及术后头痛的发生率无明显差异（P〉0．05）。结论：腰麻-硬膜外联合麻醉可显著提高麻醉的成功率，效果较好，对产妇和胎儿均是安全有效的。

Objective： To investigate the safety and effect of ropivacaine, bupivacaine and teracaine in caesarean section in combined spinal and epidural anesthesia. Methods. Ninety parturients were randomly divided into three groups. Made high density mixture from 0. 89% ropivacaine （group A）, 0. 75% bupivacaine （group B） and 1% teracaine （group C） 1 ml, respectively puls, 10% glucose 1 ml and 3% ephedrine 1 ml respectively. In all parturients, a Tuohy needle （B. D） was introduced into the L23 epidural space, and 24 3 ml medicine was injected into subarachnoid space in 0.1 ml/s. Parturients received extradural injection 0.89% ropivacaine or 2% lidocaine 5410 ml to maintain block level. To compare difference in sensory block, motor block and recovery time in three groups. Side-effects and effect on neonate score were observed. Results. The onset time of maximum sensory block and motor block in group A was prolonged compared with group B and group C （P 〈0.05） ; There were no significantly difference in maximum sensory block level in three groups （P 〉0.05） ; Effect time in group A was shorter than group B and group C （P 〈0.05） ; Onset time of motor block in group A was prolonged compared with group B and group C （P 〈 0.05）, maximum Bromage score was 041 in group A, significantly smaller （P 〈0.05）, time of maximum motor block was prolonged （P 〈0.05）, time of motor motor block disappear was shorter （P 〈0.05） ; The incidence of hypotension, nausea vomiting in group A was lower （P 〈0.05） ; Neonatal Apgar score and incidence of postoperation headache had no significantly difference （P 〉0.05）. Conclusion. Ropivacaine is safety and high effective in caesarean section in combined spinal and epidural anesthesia for parturient and neonatal.