0.75%罗比卡因与0.75%布比卡因腰麻-硬膜外联合麻醉应用于剖宫产手术的评价

Comparison of 0.75% ropivacaine and 0.75% bupivicaine for CSEA in patients undergoing cesarean section

目的 比较 ０．７５％罗哌卡因与 ０．７５％布比卡因腰麻硬膜外联合麻醉用于剖宫产手术的可行性。方法 ＡＳＡ－Ⅰ～Ⅱ级初产妇４０例于腰硬联合麻醉下行剖宫产手术，随机、双盲分两组：Ｒ组（ｎ＝２０）腰麻用药为０．７５％罗哌卡因１．２～１．４ｍｌ（９－１０．５ｍｇ）出组（ｎ＝２０）腰麻用药为０．７５％布比卡因，剂量同Ｒ组。术中两组麻醉效应不足时经硬膜外导管补充１．６％利多卡因。术中连续监测呼吸和循环状况，评估麻醉效应，并观察围术期不良反应的发生及新生儿情况。结果 两组最高阻滞平面及达到时间相似（Ｐ＞０．０５），但Ｒ组感觉和运动神经阻滞起效慢，维持时间短（Ｐ＜０．０５）；下肢运动阻滞程度Ｒ组显著低于Ｂ组（Ｐ＜０．０１）；术中Ｒ组有４例（２０％）发生心动过缓，Ｂ组５例（２５％）出现主观气促感；新生儿 Ａｐｇａｒ评分及脐动脉血气值在正常范围内．两组比较无差异（Ｐ＞０．０５）。结论 ０．７５％罗哌卡因用于硬腰联合麻醉剖腹产手术安全有效，与０．７５％布比卡因相比，下肢运动阻滞弱且恢复迅速。

Objective To evaluate the efficacy and safety of 0.75% ropivacaine versus 0.75% bupivicaine for combined spinal and epidural anesthesia(CSEA) for cesarean section. Methods Forty primiparae(ASA Ⅰ-Ⅱ) scheduled for elective cesarean section were divided into two groups: ropivacaine group received 0.75% ropivacaine 1 .2-1 . 4ml(9-10. 5mg) for spinal anesthesia and bupivicaine group received same amount of 0.75% bupivicaine. During operation when spinal analgesia was inadequate, 1.6% lidocaine was supplemented via epidural catheter. Blood pressure , heart rate and SpO2 were monitored. Sensory block(pin prick), motor block(modified Bromage scale), quality of analgesia and relaxation of abdominal wall were assessed. Apgar score of the neonates and umbilical artery blood gas as well as side effects were recorded. Results There was no significant difference between the two groups in age, height, body weight of the patients and duration of operation. The height of block was comparable between the two groups but the onset time was longer and duration of block was shorter in ropivacaine group. Analgesia and muscle relaxation were satisfactory and Apger score was 10 at 1 mm and 5mm in both groups. Blood gas values were within normal range in both groups. Motor block was weaker with ropivacaine than that with bupivacaine(P <0.01). SpO2 was maintained above 95% during operation in both groups. Bradycardia occurred in a patient in ropivacaine group. The incidence of hypotension was comparable between the two groups(45 % vs 50 %). The incidence of postoperative nausea and vomiting and headaehe was similar between the two groups. Conclusions 0.75% ropivicaine for CSEA is effective and safe for both parturient and neonate. The recovery from motor block is faster with ropivacaine than that with bupivacaine.