罗哌卡因用于剖宫产术后横纹肌平面阻滞镇痛的效果分析

Evaluation of the clinical effect of ropivacaine on caesarean operation

目的 探讨罗哌卡因应用于剖宫产术后腹横肌平面阻滞中的疗效及应用的安全性.方法 回顾性分析来我院采用罗哌卡因应用于剖宫产手术后腹横肌平面阻滞的60例产妇的临床资料.腹横肌平面阻滞后各时间点进行采血和询问有无神经毒性症状,测量血浆总罗哌卡因浓度;对比分析有无神经毒性症状产妇的年龄、体质量、身高、BMI和罗哌卡因应用总剂量等临床特征,并比较血浆总罗哌卡因平均峰浓度和达到峰浓度所用时间,以评价出现神经毒性症状的血浆罗哌卡因阈浓度和给药剂量是否合适.结果 有症状组产妇体质量（70.30±7.90） kg和罗哌卡因应用总剂量（225.80±17.60） mg显著高于无症状组（62.60±12.40） kg、（189.00±22.40） mg,差异有统计学意义（t=4.613、t=7.143,P均＜0.05）;有症状组产妇血浆总罗哌卡因平均峰浓度显著高于无症状组产妇[（2.82±0.55） mg/L与（1.33±0.47） mg/L,差异有统计学意义（t=0.779,P＜0.05）,而有症状组产妇达到峰浓度所用时间显著短于无症状组[（26.80±5.40） min与（39.20±6.30） min,差异有统计学意义（t=4.158,P＜0.05）.结论 罗哌卡因在剖宫产术后腹横肌平面阻滞中,存在一定的神经毒性,罗哌卡因血浆总浓度2.2 mg/L是判定临床毒性较为合理阈浓度;并且2.5 mg/kg罗哌卡因的应用剂量只适用于体质量相对较轻的产妇,而对于体质量过大的产妇将不适用于该剂量,应适当降低罗哌卡因的应用剂量.

Objective To explore the toxic effect and application safety of ropivacaine after transversus abdominis plane block for caesarean section.Methods Sixty cases puerperas who were suffered with transversus abdominis plane block for caesarean section in the People＇ s Hospital of Yan＇ an were retrospectively analyzed.Blood sample was collected after TAP block at different times and at the same time asked if they had neurotoxicity.The collected blood was measured for the concentration of ropivacaine.The ages,weight,height,BMI and total doses of ropivacaine were compared,and the mean total peak ropivacaine concentrations and the mean time to the maximum concentration in symptomatic and asymptomatic puerperas were compared to assess the reasonable threshold for clinical in symptomatic puerperas and suitable ropivacaine concentration.Results The BMI and total doses of ropivacaine of symptomatic group was （70.30±7.90） kg,（225.80±17.60） mg,significantly higher than the asymptomatic group （（62.60±12.40） kg,（189.00±22.40） mg）,the differences were significant（t=4.613,7.143,P〈0.05）.The mean total peak ropivacaine concentrations in symptomatic group was increased compared with asymptomatic group （（2.82±0.55） mg/L vs.（1.33±0.47） mg/L,t=0.779,P〈0.05）,and the mean time to the maximum concentration in symptomatic group was decreased compared with asymptomatic group （（26.80±5.40） min vs.（39.20±6.30） min,t=4.158,P 〈0.05）.Conclusion There is a certain neurotoxicity when applying ropivacaine after transversus abdominis plane block for caesarean section.Ropivacaine concentration 2.2 kg/ml as a reasonable threshold for clinical toxicity in puerperas undergoing TAP block,and 2.5 mg/L ropivacaine is fit for puerperal on lean body mass,and further reduction may be required as puerperal weight increases.