不同浓度罗哌卡因腰麻-硬膜外联合阻滞用于剖宫产手术的临床观察

Efficacy of different concentrations of ropivacaine in combination with spinal-epidural anesthesia for cesarean section

目的：比较不同浓度罗哌卡因用于剖宫产的疗效,以探讨罗哌卡因腰麻-硬膜外联合麻醉用于剖宫产的最佳浓度。方法：60例ASAⅠ--Ⅱ级择期行剖宫产手术的患者,随机分成3组,选L2--3间隙行腰硬联合穿刺后,蛛网膜下腔分别注入0.66%,0.5%,0.33%3种不同浓度罗哌卡因,比较3组患者感觉、运动阻滞的起效时间、阻滞程度和恢复时间的差异,以及麻醉后生命体征变化、不良反应等。结果：3组患者镇痛效果均满意,但0.33%罗哌卡因组患者麻醉起效慢,肌松效果较差;0.66%罗哌卡因组患者麻醉后低血压发生率明显高于其他两组。结论：0.5%罗哌卡因在起效时间、阻滞程度、恢复时间及不良反应发生等综合评估中效果较好,是一种应用于剖宫产手术中较为理想的麻醉浓度。

Objective： To explore optimal concentration of ropivacaine in combination with spinal-epidural anesthesia for cesarean section. Methods： Sixty parturients （ASA l or II） scheduled for selective casarean section were randomly devided into 3 groups （ n = 20 each） , and spinally treated with hyperbaric mixture of 0.66% , 0.50% and 0.33% ropivacaine in 10% glucose. Blood pressure, heart rate and SpO2 were assessed. Sensory and motor block, recovery, and side effects were observed. Results： There was no significant difference among three groups in analgesia during surgery. However, the onset time was later in 0.33% group（P 〈0.05） , and incidence of hypotension was higher in 0.66% group. Conclusion： Ropivacaine at 0.5% may be an effective and safe concentration in combination with spinal-epidural anesthesia for cesarean section.