三种局麻药对剖宫产患者硬膜外腔弥散效果

Comparison of Epidural Dispersion Effects of Three Local Anesthetics in Cesarean Section Patients

目的：探讨盐酸利多卡因、盐酸左布比卡因、甲磺酸罗哌卡因在剖宫产患者硬膜外腔的弥散效果。方法：择期拟行剖宫产手术的患者90例，年龄20—35岁，无连续硬膜外腔麻醉禁忌证，既往无椎管内麻醉史，ASA分级Ⅰ～Ⅱ级。采用随机数字表法分为三组（n=30）：2％利多卡因组（A组）、0．5％左布比卡因组（B组）、0．894％罗哌卡因组（C组）。三组均采用2％利多卡因3ml作为实验量，追加量3-5ml／次，间隔5min分次给予，阻滞范围达S3-5-T8-6时停止给药，开始手术。比较各组手术开始时局麻药用量，观察胎儿娩出后10min各组感觉平面阻滞范围，肌松程度、新生儿阿氏评分。结果：A组及C组手术开始时用药量均显著低于B组（P〈0．05）；胎儿娩出后10min，C组感觉平面阻滞范围显著高于B组（P〈0．05），但与A组比较差异无统计学意义；术中肌松效果B、C组均显著优于A组（P〈0．05），B组和C组比较差异无统计学意义；三组新生儿阿氏评分比较差异无统计学意义。结论：利多卡因与罗哌卡因在剖宫产患者硬膜外腔的弥散效果均优于左布比卡因，但罗哌卡因的肌松效果显著优于利多卡因，三种局麻药上述用量时对新生儿阿氏评分的影响无统计学差异。

Objective： To investigate the epidural dispersion effects of the lidocaine hydrochloricle, hydrochloric acid levobupivacaine, and ropivacaine mesylate in cesarean section patients. Method： Ninety ASA I - II cesarean section patients of aged 20-35 years old, no continuous epiclural anesthesia contraindications, who had no history of spinal anesthesia, were selected in the study. They were randomly divided into three groups （ n=30 ） ： 2% lidocaine group （ group A ）, 0.5% levobupivacaine group （ group B ）, 0.894% ropivacaine group （ group C ） . All the patients were given 2% lidocaine 3 ml as experimental dosage, and the patients were given corresponding local anaesthetic every time 3-5 ml interval 5 rain, block ranged to S3_5-Ts~, stopped to medicine and start the operation. To Compare local anesthetic dosages of three groups before operation, observed the block range of the three groups after 10 rain the baby delivered, the muscle relaxation degree, neonatal Apgar score. Result： Local anaesthetic dosages of the group A and group C were significantly lower than the group B （ P〈0.05 ） . The block range of group C after 10 min the baby delivered was significantly higher than that of group B （ P〈0.05 ）, with no significant difference compared with group A. The muscle relaxation degree of group B and group C was significantly better than group A （ P〈0.05 ）, with no significant difference between group B and group C. Neonatal Apgar scores of the three groups were not statistically different. Conclusion： Lidocaine and ropivaeaine display superior epidural dispersion effects than levobupivaeaine in cesarean section. The muscle relaxation effect of ropivacaine is significantly superior to lidocaine. Three local anesthetics above dosage are no significant effect on neonatal Apgar score.