罗哌卡因腰麻-硬膜外联合阻滞一点法和两点法在剖宫产手术和术后镇痛中的应用

目的罗哌卡因腰麻-硬膜外联合阻滞一点法和两点法在剖宫产手术和术后镇痛中的应用比较。方法择期行剖宫产术病人62例,ASAⅠ或Ⅱ级,年龄20～35岁,随机分为2组:A组一点法(L2,3)腰麻-硬膜外联合阻滞,腰麻时用0.5%罗哌卡因2mL,术后镇痛时用0.125%的罗哌卡因。B组两点法(T12L1,L3,4)T12L1先行硬膜外置管为术后镇痛用药点,腰麻时选L3,4为穿刺点,腰麻的用药量,注药时间和浓度均相同以及2组术后镇痛用药量,浓度也均相同。记录感觉阻滞的起效时间、持续时间、术中麻醉质量,以及术中循环情况,不良反应及术后镇痛效果。结果 2组在下肢感觉阻滞完善时间,术中麻醉质量,感觉阻滞持续时间及Bromage评分比较差异无统计学意义(P>0.05),术中A组血压下降与B组相比有统计学意义(P<0.05),恶心呕吐的发生率较B组高有统计学意义(P<0.05),在术后镇痛中与B组相比有统计学意义(P<0.05)。结论在剖宫产术及术后镇痛中两点法比我们临床常用的一点法的效果优越。

Objective Ropivacaine spinal-epidural point method and the two points method in cesarean section patients in surgery and postoperative analgesia Comparison.Methods Patients undergoing elective cesarean section in 62 cases,ASA Ⅰ or class Ⅱ,aged 20 to 35 years old,were randomly divided into two groups：A group of that Act（L2,3）spinal-epidural,spinal anesthesia with ropivacaine 0.5%,2ml,postoperative analgesia with 0.125% ropivacaine.B group two-point method（T12L1,L3,4）T12L1 first epidural catheter for postoperative analgesic medication points,spinal anesthesia election L3,4 for the puncture point,the dosage of spinal injection,time and concentration the same postoperative analgesia as well as dosage,concentrations were the same.Sensory block onset time,duration,intraoperative quality of anesthesia,and intraoperative cycle conditions,adverse reaction rates and postoperative analgesia.Results There was complete sensory block of time in the lower extremities,intraoperative quality of anesthesia,duration of sensory block and the Bromage score difference was not statistically significant（P0.05）,patients in group A the highest sensory block higher plane than the B group,blood pressure compared with the B group was significantly（P0.05）,lower incidence of nausea and vomiting was significantly higher group B（P0.05）,postoperative analgesia in group B compared with statistics significance（P0.05）.Conclusion cesarean section and postoperative analgesia in two-point method than the clinical effects of commonly used point method is superior.