不同剂量等比重罗哌卡因蛛网膜下腔麻醉在剖宫产术中的应用研究

The clinical research on spinal anesthesia with different dose of isobaric ropivacaine in caesarean section

目的观察不同剂量0.5%等比重罗哌卡因蛛网膜下腔麻醉在剖宫产术中应用的临床疗效。方法选择150例ASA I～Ⅱ级行剖宫产手术的产妇,随机分为A、B、C三组,每组50例。于L2-3间隙蛛网膜下腔穿刺成功后分别注入0.5%等比重罗哌卡因10 mg、12.5 mg、15 mg。观察三组患者血液动力学指标、麻醉效果及三组不良反应发生率。结果 (1)血液动力学指标:①平均动脉压(MAP):A、B、C三组在各时间点显示MAP数值均无显著性(P>0.05)。②心率(HR):C组麻醉后10 min时,HR较A、B两组明显升高(P<0.05)。(2)麻醉效果:①三组感觉阻滞平面比较无显著性差异(P>0.05)。②A组运动阻滞时间明显长于B、C两组,差异有显著性(P<0.05)。③A组的运动阻滞恢复时间明显短于B、C两组,差异有显著性(P<0.05)。(3)A组硬膜外追加药物剂量明显增加,与其它两组比较有显著性差异(P<0.05)。(4)C组麻黄素的应用剂量与A、B两组比较显著性增高,差异有统计学意义(P<0.05)。(5)不良反应:A、B两组麻醉后低血压、恶心、呕吐不良反应的发生率均明显低于C组,差异有显著性(P<0.05)。麻醉后寒战反应对比观察显示B、C组的发生率明显低于A组,差异有显著性(P<0.05)。结论 0.5%罗哌卡因等比重液12.5mg剂量应用于剖宫产蛛网膜下腔阻滞更为有效、安全、副作用低。

Objective To observe the effect of spinal anesthesia with different dose of 0.5% isobaric ropivacaine in caesarean section（CS）.Methods One hundred and fifty pregnant women undergoing CS in Fang Shan District No.1 Hospital from January,2009 to December,2010.All these patients were randomly divided into three groups.Their physical status were grade I orⅡ according to Anesthesiologist Association of America（ASA）.After a puncture was successfully imbedded into the subarachnoid space between the second and third lumbar vertebra.0.5% isobaric ropivacaine 10 mg（group A）,12.5mg（group B）,and 15mg（group C） were injected into the subarachnoid space.The hemodynamics,anesthesia effect,and side effects were observed in all three groups.Results There was no difference in mean arterial pressure（MAP） in three groups at the time before the anesthesia（T0）,10 minutes after the anesthesia（T1）,and 10 minutes after the operation（T2）（P 0.05）.The heart rate（HR） in group C was significantly higher than that in group A and group B at the time T1（P 0.05）.There was no difference in sensory level in three groups（P 0.05）.The motor block time in group A was significantly longer than that in group B and group C（P 0.05）.The motor recovery time in group A was significantly shorter than that in group B and group C（P 0.05）.The additional requirement of epidural lidocaine in group A was significantly higher than that in group B and group C（P 0.05）.The requirement of ephedrine in group C was significantly higher than that in group A and group C（P 0.05）.The incidence of nausea,vomiting,and hypotension in group C was significantly higher than those in group A and group B（P 0.05）.The shivering in group A was significantly higher than that in group B and group C（P 0.05）.Conclusion 0.5% isobaric ropivacaine 12.5 mg is more suitable for spinal anesthesia in CS than other doses because it is effective,safe,and of the fewest side effects.