盐酸氯普鲁卡因在分娩镇痛改剖宫产麻醉中的应用

Application of chloroprocaine in. anesthesia for cesarean section changing from labor analgesia

目的比较盐酸氯普鲁卡因和罗哌卡因与利多卡因混合液在分娩镇痛改剖宫产硬膜外麻醉中的应用效果。方法硬膜外分娩镇痛拟改剖宫产产妇40例，随机分为观察组和对照组，每组20例。观察组硬膜外注入3％盐酸氯普鲁卡因20ml，对照组注入罗哌卡因与利多卡因混合液20ml，观察两组患者舒张压（DBP）、心率（HR）和脉搏氧饱和度（SpO2）的变化，及麻醉起效时间、运动阻滞时间、注药至手术开始时间、最高阻滞平面、达最高阻滞平面时间、痛觉恢复时间、运动完全恢复时间和肌肉松弛程度。结果与麻醉前比较，对照组产妇的DBP在注药后15min开始明显降低，HR明显增快，而观察组产妇的DBP在注药后5min即开始降低，HR明显增快，并且与对照组比较，观察组患者的DBP和HR在注药后5min和10min变化更明显；观察组麻醉起效时间、运动阻滞起效时间、达最高阻滞平面时间、痛觉恢复时间和运动完全恢复时间较对照组明显缩短（P〈0．05），观察组注药至手术开始时间为（7．2±1．5）min，对照组为（17．2±1．8）min，差异有统计学意义（P〈0．05）。结论氯普鲁卡因用于分娩镇痛改剖宫产的硬膜外麻醉起效快、感觉和运动阻滞效果好、缩短手术开始时间，且运动功能恢复快。

Objective To compare the application efficacy of chloroprocaine or ropoivacaine and lidocaine on epidural anesthesia for cesarean section changing from labor analgesia. Methods Forty parients undergoing cesarean section changing chloroprocaine 20 ml（ the observation group） from labor analgesia were randomly allocated to receive 3 % or ropoivacaine and lidocaine 20 ml （the control group ） , with 20 cases in each group. The changes of DBP, HR and SpO2, the onset time of epidural block, the times of motor block, injection to surgery, maximum upper block level appearance, pain recovery, and motor recovery completely were recorded. The upper block level and degree of muscle relaxation were observed as well. Results Compared with pre-anesthesia, the DBP in the observation group began to decrease after injection for 5 min, HR significantly increased, while 15 rain in the control group. In the control group, the change of DBP and HR were more obvious after injection 5 min and 10 min in the observation group. The onset time of epidural block, the times of motor block, maximum upper block level appearance, pain recovery, and motor recovery completely in the observation group were significantly shorter than those in the control group（P 〈 0.05）. The time injection to surgery was（7.2 ± 1.5 ）min in the observation group, which was significantly shorter than that in the control group （ P 〈 0.05 ）. Conclusions Epidural anesthesia with chloroproeaine in cesarean section changing from labor analgesia has the advantages of rapid onset time, reliable sensory and motor blockade, to shorten the operation starting time and earlier recovery of motor blockade.