不同浓度的罗哌卡因经蛛网膜下腔阻滞在剖宫产手术麻醉中的临床研究

Clinical Research on the Use of Ropivacaine with Different Concentration by Subarachnoid Block in Anesthesia of Uterine-incision Delivery

目的探讨不同浓度的罗哌卡因经蛛网膜下腔阻滞在剖宫产手术中的临床效果。方法选择择期行剖宫产手术孕足月单胎产妇90例,ASA分级Ⅰ～Ⅱ级,每组30例,随机分成3组。Ⅰ组,经蛛网膜下腔注入0.5%罗哌卡因2.5ml;Ⅱ组,经蛛网膜下腔注入0.375%罗哌卡因2.5ml;Ⅲ组,经蛛网膜下腔注入0.25%罗哌卡因2.5ml;观察注药后患者血压、心率变化、记录麻醉起效时间、最高感觉阻滞平面、达最高感觉平面的时间、最大运动阻滞评分、达最大运动阻滞时间、麻醉效果评价、术中不良反应(恶心、呕吐、低血压、寒战)、新生儿1、5minApger评分。结果①3组患者BP在麻醉后5、10min时间点较麻醉前有所降低,其中组内比较Ⅰ(5、10min)、Ⅱ(5min)与麻醉前比较有统计学意义(P<0.05);组间比较在5、10minⅠ、Ⅲ有统计学意义(P<0.05);②感觉起效时间、最高感觉阻滞平面、达最高感觉阻滞平面时间、达最大运动阻滞时间组间比较差异无统计学意义;③运动阻滞Bromage评分:Ⅰ、Ⅱ组高于Ⅲ组(P<0.05),Ⅰ、Ⅱ组间比较差异无统计学意义;④3组麻醉效果评价差异有统计学意义(P<0.05);其中Ⅰ、Ⅱ组优于Ⅲ组(P<0.05);Ⅰ、Ⅱ组间比较差异无统计学意义;⑤术中不良反应3组间比较差异无统计学意义;⑥无新生儿窒息。结论综合循环稳定性与麻醉效果,Ⅱ组优于其他两组,完全可以满足剖宫产手术的要求。

Objective To investigate clinical effect of ropivacaine with different concentration by subarachnoid block in anesthesia of uterine - incision delivery operation. Methods 90 ASA Ⅰ～Ⅱ womem for scheduled cesarean section were randomly divided into three group（n =30 for each） ：group Ⅰ received 2.5ml of 0.5% ropivacaine;group Ⅱ received 2.5ml of 0. 375% ;group Ⅲ received 2.5ml of 0.25% ropivacaine. Variation of BP and HR after anestha,the onset time of sensory block,max -plane of sensory block and requirement times to max - plane of sensory block, score of max - motor block and time to max - motor block, effect of anesthesia,adverse reaction during operation were obserred and recorded. Results （1）BP of three groups decreased at 5,10min after anesthesia. Group Ⅰ （5,10min） and U （5min）were lower than pro -anaesth（ P 〈 0.05 ） , and there was statistical significance at 5,10min between groups Ⅰ and Ⅲ （P 〈 0. 05 ）. （2）There was no statistical significance in onset time of sensory block, max - plane of sensory block,requirement times,time to max - motor block among three groups. （3）Seore of max - motor block of group Ⅰ and Ⅱ was higher than that of group Ⅲ. There was no statistical significance between group Ⅰ and Ⅱ. （4）Effect of anesthesia of groups Ⅰ and Ⅱ was better than that of group Ⅲ （P 〈 0.05）. （5）There was no statistical significance in operation adverse effect. （6）There was no asphyxiation among neonatus. Conclusion As for cyclical stability and good effect of anesthesia,group Ⅱ is better than group Ⅰ and Ⅲ. it can be used in delivery operation.