罗哌卡因等三种麻醉药在剖宫产中对产妇及新生儿影响的临床研究

Clinical study of the influence of ropivacaine and the other two kinds of narcotics on puerpera and newborn in cesarean delivery

目的探讨罗哌卡因与布比卡因、利多卡因硬膜外阻滞麻醉对产妇及新生儿的影响。方法拟在硬膜外阻滞麻醉下行剖宫产术的产妇718例,随机分为三组,R组(n1=254)注射0.5%盐酸罗哌卡因;B组(n2=264)注射0.5%盐酸布比卡因;L组(n3=200)注射2%盐酸利多卡因。采用序贯法进行。结果对三组硬膜外阻滞效果;药物的不良反应;阻滞完善后血压变化;新生儿出生时Apgar评分等进行临床观察,R组阻滞效果好于B组和L组。三种麻醉药不良反应:R组<B组<L组;阻滞完善后血压下降明显R组<B组<L组。新生儿Apgar评分R组高于B组及L组(P<0.05)。结论罗哌卡因比布比卡因、利多卡因较少发生中枢神经系统及心血管的蓄积,罗哌卡因在体内消除代谢能力较强,半衰期短,对子宫和胎盘血流几乎无影响,是剖宫产术麻醉效果好且安全的麻醉药。

Objective To explore the influence of epidural block anesthesia by ropivacaine, bupivacaine and lidocaine on puerpera and newborn in cesarean delivery. Methods A total of 718 puerpera, who would undergo cesarean delivery with epidural block anesthesia, were randomly divided into three groups. Group R （n1=254） took injection of 0.5% ropivacaine hydrochloride, group B （n2=264） took injection of 0.5% bupivacaine hydrochloride, and group L （n3=200） took injection of 2% lidocaine hydrochloride. Sequential method was applied in the anesthesia as fractional injection of small dose of narcotics. Results Clinical observations were made on the effects of epidural block anesthesia, adverse reactions of drugs, blood pressure changes after block, and neonatal Apgar score of the three groups. The blocking effect of group R was better than that of group B and group L. The result of adverse reactions of drugs of the three groups was group R〈group B〈group L. The result of blood pressure changes after block of the three groups was group R〈group B〈group L. The neonatal Apgar score of group R was higher than that of group B and group L （P〈0.05）. Conclusion Ropivacaine has lower incidence of accumulation in central nervous system and angiocarpy than bupivacaine and lidocaine; it has shorter half-life period, and is easier to be metabolized. Ropivacaine has rarely little influence on bloodstream in uterus and placenta, therefore it is an effective and safe narcotic for the anesthesia in cesarean delivery.