等比重罗哌卡因腰麻在剖宫产术中的应用

Using of intrathecal isobaric ropivacaine for Caesarean section

目的观察0.5%等比重罗哌卡因腰麻在剖宫产手术中的麻醉效果及并发症。方法选择100例ASAⅠ～Ⅱ拟行剖宫产手术产妇,均采用腰麻-硬膜外联合麻醉(CSEA)。随机分为两组,分别向蛛网膜下腔注射0.5%(比重1.008)布比卡因和罗哌卡因。布比卡因组给予7～10mg,罗哌卡因组给予11～15mg。腰麻平面不足T_6者,硬膜外腔追加2%利多卡因。结果两组均于蛛网膜下腔注药后20分钟达到最高平面,均为T_4(T_6～T_2)。运动阻滞分级在注药60分钟时出现显著性差异(P<0.05),罗哌卡因组运动阻滞均可在150分钟内恢复。结论 0.5%罗哌卡因可以达到与0.5%布比卡因同样的阻滞麻醉效果,产生相对较少的麻醉并发症及更轻程度的运动阻滞。0.5%罗哌卡因可以作为布比卡因的替代药物。

Objective The purpose of our study was to evaluate the clinical efficacy and safety of intrathecal with 0. 5% isoharie ropivacaine. Methods One hundred parturients presenting for cesarean delivery were randomly assigned to one of the 2 groups. Group B received intrathecal isobaric bupivacaine 7 - 10mg, Group R received in- tratheeal isobaric ropivacaine 11 - 15mg. Patients were monitored for sensory and motor blockages and side effects. Results 0.5 % isobaric ropivaeaine, compared with 0.5 % isobaric bupivaeaine, produced spinal anesthesia of similar and eftective clinical quality with shorter duration of motor block. There were no significant differences in the maximum extent of cephalad sensory block among the two groups （ Group B ： T4 [ T6 - T2 ] ; Group R ： T4 [ T6 - T2 ] ）. However, the time to complete recovery from motor block was longer in the Group B than the Group R（P 〈 0.001 ）. No patient had inadequate anesthesia. Apgar scores at 1rain and 5 min were similar in the two groups. With regard to side-effects, the incidence of nausea and vomiting was higher in the Group B than the Group R（P 〈 0.05）. But the incidence of hypotension was similar in both groups. Conclusions This study suggests intrathecal with 0.5% isobaric ropivacaine provides sufficient anaesthesia for caesarean delivery. The 0. 5% isobaric ropivacaine resulted in shorter motor block and similar postoperative analgesia.