罗哌卡因与布比卡因用于模拟舰船摇摆状态下连续脊麻手术的研究

Study of continuous spinal anesthesia with ropivacaine and bupivacaine in abdominal surgery in simulated ship motion

目的研究模拟舰船摇摆状态下等比重罗哌卡因与布比卡因连续蛛网膜下腔阻滞（continuous spinal anesthesia，CSA）用于腹部手术的安全性和可行性，为海上救护提供一种有效的麻醉方式。方法80例择期腹部手术患者，取L2-3间隙行连续蛛网膜下腔阻滞，根据麻醉药物和体位的不同，随机分为罗哌卡因水平位对照组（R1）、布比卡因水平位对照组（B1）、罗哌卡因模拟摇摆组（R2）、布比卡因模拟摇摆组（B2）4组，每组20例。蛛网膜下腔给药后，患者由侧卧位改仰卧位，水平对照组手术床始终置水平位，模拟摇摆组手术床按设定顺序摇摆30min，观察比较4组患者的麻醉效果、血流动力学变化以及相关的不良反应等。结果B2组麻醉平面较B1组高2．4个节段，平面固定时间较B1组延长。R2组较R1组麻醉平面固定时间延长，2组痛觉消失平面在注药后13min出现差异，2组比较差异有统计学意义（P〈0．05）。平面固定后R2组的痛觉消失平面要较R1组高2个节段。麻醉平面B2组较R2组高1．2个节段，R2组感觉阻滞起效较慢，最高锐痛觉平面下降1个节段时间较快；在镇痛和肌肉松驰效果方面，2组差异无统计学意义（P〉0．05）。在对循环影响方面，B1组、B2组注药前后MAP变化显著，R1组、R2组无明显变化。结论在体位急剧改变状态下，用0．75％罗哌卡因行CSA可用于腹部手术的配合，其镇痛及肌肉松驰效果与0．5％布比卡因相当，但对循环抑制轻，并发症少。但对此种麻醉方式，在实际应用中还需大量的临床资料验证。

Objective To investigate the feasibility and safety of continuous spinal anesthesia （CSA） with isobaric bupivacaine and ropivacaine in abdominal surgery in simulated ship motion. Methods Eighty patients who received selective abdominal surgery wi.＇th continuous spinal anesthesia were randomly divided into four groups（ n = 20）. Namely, the horizontal level with 0. 75% ropivacaine control group （R1）, the horizontal level with 0. 5% bupivacaine control group（ B1 ）, the simulated ship motion with 0.75% ropivacaine group （R2）, and the simulated ship motion with 0. 5% bupivacaine group （B2）. Effect of anesthesia, changes in hemodynamics and incidence of related side-effects were determined and compared between the 4 groups. Results The anesthetic level of group B2 was 2.4 segments higher than that of group B1 ,and the duration for the fixed level was longer than that of group B1 （P 〈 0. 05）. Duration of anesthesia level fixed time in group R2 was significant longer than that in R1. Differences could also be seen in terms of analgesic level and receding level, 13 minutes after injection. When the level of blockade was fixed ,the analgesic level in group R2 was two segments higher than that in group R1 （P 〈 0.01 ）. There were also obvious differences （P 〈0.01 ） in the onset and duration of sensory blockade between group R2 and B2, the highest analgesic level of group B2 being 1.2 segments higher than that in group R2. Anesthesia effects of group R2 and group B2 were quite similar. Mean arterial pressure （MAP） in group B1 and group B2 decreased obviously before and after intrathecal injection, while MAP in the other groups （group R1 and group R2） was more stable.Conclusions 0. 75% isobaric ropivacaine could be used for abdominal surgery in a simulated ship motion with continuous spinal anesthesia which produces a suitable and a more controllable analgesia. However, further advanced study and more clinical data are needed for its practical application.