罗哌卡因单次蛛网膜下腔阻滞对剖宫产术循环功能的影响

Effect of ropivacaine single subarachnoid block on circulatory function of cesarean section

目的探讨0.5%盐酸罗哌卡因单次蛛网膜下腔阻滞对剖宫产产妇循环功能的影响。方法选择80例急诊行剖宫产术的孕产妇,随机分为2组,于L2~3间隙行蛛网膜下腔穿刺,分别注入0.5%盐酸罗哌卡因3ml（A组）或0.5%盐酸布比卡因3ml（B组）。记录2组患者最高阻滞平面及到达最高阻滞平面所用时间,术中输液量和手术时间,记录麻醉前、麻醉后5min、麻醉后10min、麻醉后20min平均动脉压（MAP）和心率（HR）的变化。结果 2组患者最高阻滞平面均在T7,最高阻滞平面达到时间、术中输液量、手术时间比较,差异无统计学意义。A组MAP在麻醉前后变化不明显;B组MAP在麻醉后5min、麻醉后10min、麻醉后20min下降明显,与麻醉前比较,差异有统计学意义（P〈0.05）。组间比较,差异有统计学意义（P〈0.05）。2组HR麻醉后变化不明显,组间比较差异无统计学意义。结论 0.5%的盐酸罗哌卡因腰麻对血压的影响要显著小于同浓度的盐酸布比卡因,对患者循环功能影响小,安全性高于盐酸布比卡因,适用于急诊剖宫产术的麻醉。

Objective To study the effect of ropivacaine single subarachnoid block on circulatory function of cesarean section.Methods Eighty patients with emergency cesarean section,were randomly divided into two groups,subarachnoid puncture in L2~3,were injected 0.5% ropivacaine 3ml（A group） or 0.5% bupivacaine 3ml（B group）.Recorded the highest block plane,arrival time,intraoperative fluid volume,surgical time,MAP and HR before anesthesia,5 minutes,10 minutes,20 minutes after anesthesia of 2 groups.Results The highest block plane of 2 groups was T7.There was not significant difference in the time reached highest block plane,intraoperative transfusion,operation time.MAP of A group did not change significantly before and after anesthesia; MAP of B group after anesthesia 5min,anesthesia 10min,20min after anesthesia decreased significantly compared with those before anesthesia,the difference was statistically significant（P0.05）.The difference was statistically significant between the two groups（P0.05）.HR groups did not change significantly after anesthesia,the difference was not statistically significant between two groups.Conclusion Effect of 0.5% ropivacaine hydrochloride spinal anesthesia on blood pressure is significantly less than the same concentrations of bupivacaine,little effect on circulatory function in patients with high security in bupivacaine for emergency cesarean section anesthesia.