不同剂量罗哌卡因腰硬联合麻醉对剖宫产产妇循环功能的影响

Dose-dependent effects of Ropivacaine on maternal hemodynamics in combined with spinal-epidural anesthesia for cesarean delivery

目的探讨不同剂量的罗哌卡因腰硬联合麻醉对剖宫产产妇循环功能的影响。方法选择90例择期行剖宫产术的孕产妇,按数字表法随机分为三组,行腰麻-硬膜外联合麻醉(CSEA),分别在蛛网膜下腔注入0.5%罗哌卡因(75 mg罗哌卡因+0.9%生理盐水15 ml)2.0 ml(A组)、1.8 ml(B组)和1.6 ml+硬膜外2%盐酸利多卡因3 ml(C组)。记录各组麻醉至手术开始的时间和手术的时间;观察各组麻醉阻滞效果、麻黄碱用量和硬膜外追加2%利多卡因情况;记录各组产妇在麻醉前、麻醉后仰卧、麻醉后5 min、麻醉后10 min、娩婴各时间点心率、血压的变化情况;记录产妇恶心、呕吐、低血压等情况。结果麻醉后5 min及10 min收缩压C组与A组比较,差异有统计学意义(P<0.05);娩婴时收缩压C组与A、B组比较,差异有统计学意义(P<0.05);麻醉后10 min舒张压C组与A组比较,差异有统计学意义(P<0.05);麻黄碱用量C组低于A、B组,差异有统计学意义(P<0.05);低血压发生率A、B组高于C组,差异有统计学意义(P<0.05);A、B两组各项指标比较,差异均无统计学意义。结论蛛网膜下腔给予罗哌卡因小剂量腰麻1.6 ml(8 mg)复合硬膜外追加2%盐酸利多卡因3 ml,对剖宫产产妇循环功能影响最小,副作用发生率最低。

Objective To study dose-dependent effects on maternal hemodynamics of ropivacaine in combined-spinal epidural anesthesia after cesarean section,finding the best dose of analgesia for clinical scheme of parturients.Methods Ninety patients ready for caesarean section were recruited and randomly divided into three groups and received combined spinal-epidural anesthesia（CSEA）.Patients were injected intrathecally with 0.5% Ropivacaine（Ropivacaine 75mg ＋ NS 15ml） 2.0ml（group A）,1.8ml（group B） and 1.6ml ＋ 2% epidural Lidocaine 3ml（group C）.Additional 2% Lidocaine were added if necessary.The medical indexes were observed as follows： time from anesthesia to skin incision and operation time were recorded;meanwhile the anesthetic effectiveness and the dosage of additional use of epidural 2% Lidocaine as well as patients’heart rate,blood pressure,and blood oxygen saturation at each post-anesthetic time interval（before anesthesia,supine position after anesthesia,5min after anesthesia,10min after anesthesia,childbirth） were recorded.Side effect such as nausea,vomiting and hypotension were also observed.Results The difference of systolic pressures at post-anesthetic 5min,10min between group A and group C had statistical significance（P〈0.05）.Compared with group A and group B,group C had statistical significance in difference of systolic pressure at delivery（P〈0.05）.The difference of diastolic pressure at post-anesthetic 10 minute between group A and group C showed statistical significance（P〈0.05）.Dosage of Ephedrine in group A and group B were more than that in group C,the difference had statistical significance（P〈0.05）.Hypotension in group A and group B were more often than group C,the difference had statistical significance（P〈0.05）.There was no statistic difference of indexes between group A and group B.Conclusion 1.6ml Ropivacaine（8mg） spinal anesthesia combined epidural 2% Lidocaine 3 ml can provide reliable anesthesia with the lowest incidence of side effects and has the minimal effect on maternal hemodynamics.