腹式子宫切除术中0.6%甲磺酸罗哌卡因脊髓麻醉的有效剂量

Effective dose of 0.6% Ropivacaine mesylate for spinal block of combined spinal-epidural anesthesia of abdominal hysterectomy

目的观察研究0.6%甲磺酸罗哌卡因在腹式子宫切除术腰麻联合硬膜外麻醉中蛛网膜下腔阻滞的有效剂量。方法随机选取妇科腹式子宫切除术患者80例,按随机数字表法分为4组,每组20例。单因素设计,采用序贯试验的Robbins-Monro法,监测血压、心电图、术中恶心、呕吐,观察感觉神经和运动神经阻滞、术后并发症及追踪1个月后肝、肾功能是否发生变化,记录达到有效剂量标准、超过有效剂量标准、未达到有效剂量标准的情况,并据此分析研究。结果在腹式子宫切除术腰麻联合硬膜外麻醉中,应用0.6%甲磺酸罗哌卡因使蛛网膜下腔阻滞达到有效标准者的生命体征平稳,心电图未见明显变化,术中偶有恶心,无呕吐。其半数有效剂量(ED50)为15.33 mg,95%可信区间为13.56,16.76。结论 0.6%甲磺酸罗哌卡因可以安全有效地应用于腰麻联合硬膜外麻醉蛛网膜下腔阻滞,ED50为15.33 mg,无明显毒副作用,对循环影响较轻。

Objective To study the effective dose of 0.6% Ropivacaine mesylate for spinal block of com- bined spinal-epidural anesthesia in abdominal hysterectomy. Methods Eighty patients of elective abdominal hysterectomy were selected randomly, given serial number and divided into four groups （20 in each group） ac- cording to the random number table. Single factor design was carried out for Robbins-Monro＇s procedure of sequential trials. The level of anesthesia plane of sensory nerve block and motor nerve block was observed. Blood pressure, electrocardiogram, nausea and vomiting were monitored, and postoperative side effects, changes in liver and kidney function one month after operation were tracked. Some criteria such as the effective-dose standard, the standard of over effective-dose and suboptimal dose standard were evaluated and recorded. The results were analyzed by statistic software 19.0. Results When the optimal standard of spinal block was at- tained by 0.6% Ropivacaine mesylate, the patients had smooth and steady life signs, and showed no changes of heart rhythm on ECG, sometimes nausea but no vomiting during operation. The median effective dose （ED50） was 15.33 mg, 95% confidence interval was from 13.56 to 16.76. Conclusions 0.6% Ropivacaine me- sylate can be used safely and effectively for spinal block with combined spinal-epidural anesthesia. Its ED50 is 15.33 mg. It does not have significant toxic or side effects, and only produces mild effect on circulation system.