比较盐酸罗哌卡因/盐酸布比卡因腰麻-硬膜外联合阻滞下实施剖宫产手术对产妇与新生儿预后的影响

Clinical Observation of the Ropivacaine and Bupivacaine for Combined Spinal-epidural Anesthesia in Cesarean Sections

目的：观察盐酸罗哌卡因与盐酸布比卡因用于腰麻-硬膜外联合阻滞在剖宫产术中的麻醉效果、不良反应及对新生儿预后的影响。方法：ASA分级Ⅰ~Ⅱ、拟行剖宫产手术的低危产妇120例，随机分为两组接受腰麻-硬膜外联合阻滞：罗哌卡因组（R组），给予患者罗哌卡因11 mg单次腰麻；布比卡因组（B组），给予患者布比卡因11 mg单次腰麻；对于两组中手术时间长于1 h的患者，从硬膜外导管追加2%利多卡因5 ml。监测血流动力学变化，比较两组手术时间、感觉阻滞起效时间、到达最高阻滞平面时间、最高阻滞平面消退/感觉恢复时间、运动阻滞起效时间、运动完全恢复时间、镇痛效果、最大Bromage评分、肌松效果、评估麻醉效应和胸闷、恶心呕吐等不良反应发生情况；评估新生儿Apgar评分，测定分娩即刻脐动脉血pH值。结果：罗哌卡因组的感觉阻滞起效时间、到达最高阻滞平面时间显著短于布比卡因组（P〈0.05）；罗哌卡因组的运动阻滞起效时间、达最高改良Bromage分值时间明显慢于布比卡因组（P〈0.05），而运动完全恢复时间显著快于布比卡因组（P〈0.05）。两组镇痛效果、肌松效果、新生儿Apgar评分、手术时间、感觉恢复时间比较，差异均无统计学意义（P〉0.05）；两组血压与心率的比较，R组效果更佳（P〈0.05）；两组术后恶心呕吐、呼吸抑制等不良反应比较，差异均无统计学意义（P〉0.05）。结论：两种麻醉方法均可以满足临床需要，但罗哌卡因组麻醉总体效果优于布比卡因组，运动神经阻滞恢复更快，便于产妇早期下床活动。

Objective：To evaluate the latency and duration of analgesia and maternal and fetal repercussions with bupivacaine hydrochloride and ropivacaine hydrochloride in combined spinal-epidural anesthesia for cesarean section.Method：120 cases of cesarean section operation singleton term parturients were randomly divided into two groups：Ropivacaine group（group R）,patients were given 11 mg ropivacaine;Bupivacaine group（group B）,patients received bupivacaine 11 mg.Monitoring the changes of hemodynamics,operation time,compared two groups of sensory block onset time,block level,at the top of the highest time block plane,sensory recovery time,motor block onset time,recovery time,the analgesic effect of movement,the maximum Bromage score, muscle relaxation effect,neonatal Apgar score,assessment of anesthetic effect and tightness in the chest,nausea and vomiting the incidence of adverse reactions. Result：The amount of sensory block onset time,block level reached the highest time in group R were significantly shorter than group B（P〈0.05）,group R of motor block onset time,reaching the highest modified Bromage score was significantly slower than group B（P〈0.05）,and complete recovery time was significantly faster movement than group B（P〈0.05）.The analgesic effect,two groups of muscle relaxation effect,neonatal Apgar score,operation time,recovery time,feeling wrer no significant difference between the two groups in blood pressure and heart rate,compared with group B,a better effect of ropivacaine group,the difference was statistically significant（P〈0.01）,no significant difference in nausea and vomiting,respiratory depression adverse reactions of the two groups after operation. Conclusion：Two kinds of anesthesia methods can meet the clinical needs,but the effect of group R was better than that of group B,and has less adverse reaction.