罗哌卡因腰-硬联合麻醉对剖腹产孕妇血流动力学及麻醉质量的影响

Impact of ropivacaine combined spinal epidural anesthesia on hemodynamic and anesthesia quality in cesarean section pregnant women

目的观察小剂量盐酸罗哌卡因腰-硬联合麻醉对剖腹产孕妇血流动力学及麻醉质量的影响。方法 132例行择期剖宫产术产妇随机分为试验组和对照组,每组各66例。均经L2-L3腰椎间隙行蛛网膜下腔穿刺麻醉,试验组给予0.75%罗哌卡因1 m L+注射用水2 m L;对照组给予0.75%罗哌卡因2 m L+注射用水1 m L,观察2组心率(HR)、平均动脉压(MAP)、血氧饱和度(Sp O2)、麻醉平面固定时间、麻醉时间、肌松满意度和不良反应发生情况。结果麻醉前、麻醉15 min和手术结束后,2组HR、MAP、Sp O2差异无统计学意义(P>0.05)。胎儿分娩后对照组HR(89.3±9.7)times·min-1明显增快,MAP(97.0±10.3)mm Hg和Sp O2(95.1±0.7)%明显降低(P<0.05)。2组产妇在麻醉平面、麻醉时间及肌松满意度比较差异无统计学意义(P>0.05)。试验组产妇麻醉苏醒时间(19.27±3.19)min和自主排尿时间(18.42±2.12)h均早于对照组(P<0.05),2组新生儿娩出后1 min Apgar评分比较差异无统计学意义(P>0.05)。试验组不良反应发生率(7.58%)显著低于对照组(28.79%,P<0.05)。结论小剂量盐酸罗哌卡因腰-硬联合麻醉有助于剖宫产手术患者血流动力相对稳定,提高麻醉质量。

Objective To study the effect of small doses ropivacaine combined spinal epiduraI anesthesia on hemodynamie and anesthesia quality in cesarean section pregnant women. Methods A total of 132 cases pregnant women with cesarean section were divided into experimen- tal group and control group, all patients given L2, L3 lumbar line com- bined with spinal epidural anesthesia. Experimental group were given 0. 75% ropivacaine 1 mL ＋ 2 mL water injection; control group given 0. 75% ropivacaine 2 mL ＋ 1 mL water injection. Heart rate （HR） , mean artery pressure （MAP）, oxygen saturation （SpO2）, anesthesia plane fixed time, anesthesia time, muscle relaxant satisfaction, adverse reactions were compared between the two groups. Results Before anes- thesia, 15 min after anesthesia and operation completed, there were no statistical significance of HR, MAP, SpO2 between the two groups （ P 〉 0.05 ）. After fetal childbirth, HR （ 89.3± 9.7 ） times · min- 1 in control group was significantly faster, MAP （97.0 ± 10.3 ） mmHg and SpO2 （95.1 ± 0. 7 ） % significantly decreased （ P 〈 0. 05 ）. There were no statistical significance of anesthesia plane, anesthesia time, muscle relaxant between the two groups （ P 〉 0. 05 ） ; mater- nal anesthesia awakening time （19. 27 ＋3.19） rain and automatic micturition time （18.42 ＋2. 12） h in experimental group were shorter than those of control group （ P 〈 0. 05 ）. There was no statistical significance of neonatal 1 min Apgar score between the two groups （P 〉 0. 05 ）. The incidence rate of adverse reactions in experimental group （7.58%） was significantly lower than that in control group（28.79%, P 〈0. 05）. Conclusion Small doses ropiva- caine combined with spinal epidural anesthesia helped hemodynamic of pregnant women to be relative stability, and could improve the quality of anesthesia.