硬膜外腔不同给药方式对罗哌卡因作用的影响

Comparison of different epidural administration ways for ropivacaine in patients undergoing gynecologic surgery

目的观察罗哌卡因不同给药方式对下腹部手术硬脊膜外腔阻滞效果的影响。方法择期行妇科手术的108例患者随机分为4组:A组24例,予甲磺酸罗哌卡因单次给药(12mL);B组24例,予盐酸罗哌卡因单次给药(12mL);C组30例,予甲磺酸罗哌卡因分两次给药(6mL+6mL);D组30例,予盐酸罗哌卡因分两次给药(6mL+6mL)。各组用药均不含肾上腺素。观察痛觉完全消失时间、麻醉持续时间、硬脊膜外腔阻滞范围及运动阻滞恢复时间,记录术中心率(HR)、平均动脉压(MAP)和脉搏血氧饱和度(SpO2)的改变。结果给药后4组患者的HR均无明显变化,组间的差异亦无统计学意义(P值均>0.05),4组患者SpO2均>97%。注射药物后10min,4组的MAP均显著低于基础值(P值均<0.05);注射药物后20min,C、D组的MAP均显著高于A、B组(P值均<0.05)。A、B两组的痛觉消失时间均显著短于C、D两组(P值均<0.01),4组间的麻醉持续时间、阻滞范围、运动阻滞时间的差异均无统计学意义(P值均>0.05)。结论甲磺酸罗哌卡因的硬脊膜外腔阻滞效能与盐酸罗哌卡因相仿,单次给药的起效时间较分两次给药短,有利于加快麻醉的速度,单次给药可能比分次给药更安全,但寒战的发生率较高。

Objective To compare the effects of different administration ways for ropivacaine epidurally in patients undergoing gynecologic surgery. Methods A total of 108 patients scheduled for selective gynecologic surgery were assigned to 4 groups. Group A （n = 24） received ropivacaine mesilate in single dose （12 mL） group B （n = 24） received ropivacaine hydrochloride in single dose （12 mL）~ ropivacaine mesilate （6 ml ＋ 6 mL） was given two times in group C （n =30） and ropivacaine hydrochloride （6 mL＋ 6 mL） was given two times in group D （n = 30）. There was no epinephrine in all the drugs. Onset time of sensation block, duration of anesthesia, range of epidural block and recovery time of motor were recorded. During the procedure, heart rate （HR）, mean arterial pressure （MAP） and saturation of peripheral oxygen （SpO2） were monitored and recorded. Results HR was not significantly changed among the 4 groups after epidural block （ P〉0.05）, and SpO2 was over 97%. MAP was significantly decreased 10 min after epidural administration in the 4 groups （P〈0.05）. MAP in groups C and D was significantly higher than that in groups A and B 20 min after epidural administration （P〈0,05）. Onset time of sensation block in groups A and B was significantly shorter than that in groups C and D （P〈0.01）. Duration of anesthesia, range of epidural block, and recovery time of motor were not significantly different among the four groups （P〉0.05）. Conclusion The efficacy of epidural .ropivacaine mesilate is similar to ropivacaine hydrochloride. Compared with twice-dose, onset time of sensation block is shorter and It is safer for single-dose administration, but the incidence of shivering is higher. （Shanghai Med J, 2012, 35= 287-290）