重比重联合轻比重罗哌卡因在蛛网膜下腔麻醉剖宫产术中的应用

Combined use of hyperbaric and hypobaric ropivacaine in spinal anesthesia for caesarean section

目的 分析剖宫产术中使用重比重罗哌卡因联合轻比重罗哌卡因的蛛网膜下腔麻醉与单一重比重罗哌卡因蛛网膜下腔麻醉效果及血流动力学变化. 方法 选择142例在蛛网膜下腔-硬膜外腔联合麻醉下拟行择期剖宫产术患者.根据标准纳入的患者（132例）按计算机编码被随机分配到单一重比重罗哌卡因组（A组）或重比重和轻比重罗哌卡因联合组（B组）,每组66例.主要观察指标是低血压的发生率,次要观察指标是感觉阻滞水平. 结果 两组均表现出相似的麻醉效果.A组低血压发生率比B组显著增高（74％比45％）（P＜0.05）,A组恶心发生率比B组显著增加（23％比8％）（P＜0.05）. 结论 重比重联合轻比重罗哌卡因蛛网膜下腔麻醉相比单一的重比重罗哌卡因蛛网膜下腔麻醉可提供相似的麻醉效果及更加稳定的血流动力学.

Objective To compare anesthetic effects and hemodynamic characteristics of spinal anesthesia with combined use of hyperbaric and hypobaric ropivacaine or single hyperbaric ropivacaine in patients undergoing caesarean section.Methods One hundred and forty-two patients undergoing elective cesarean delivery with combined spinal-epidural anesthesia were included in this randomized controlled study.The patients meeting inclusion criteria （n=132） were randomly allocated into either the single hyperbaric ropivacaine group （group A） or combined hyperbaric and hypobaric ropivacaine group （group B）,n=66.The primary endpoint was the incidence of hypotension.Secondary endpoints included sensory blockade levels.Results Both groups showed similar anesthetic effects.The incidences of hypotension was significantly higher in group A when compared with group B（74% vs 45%） （P〈0.05）.Group A had a higher incidence of nausea when compared with group B （23% vs 8%）（P〈0.05）.Conclusions Combined use of hyperbaric and hypobaric solution had satisfactory anesthetic effects and more stable hemodynamic characteristics compared with a single dose of hyperbaric solution in caesarean patients with combined spinal-epidural anesthesia.