罗哌卡因和布比卡因在妊娠高血压综合征剖宫产中的应用比较

Ropivacaine is superior to bupivacaine in Combined Spinal-epidural Anesthesia for Cesarean Section with Pregnancy Induced Hypertension

目的:比较罗哌卡因和布比卡因腰-硬联合麻醉在妊娠高血压综合征(PIH)剖宫产中的应用效果。方法:100例择期剖宫产孕产妇,均合并有PIH,随机均分为罗哌卡因组(R组)和布比卡因组(B组),每组50例。两组均经L_3~L_4腰椎间隙行腰-硬联合麻醉,R组腰麻用0.75%罗哌卡因1.5 mL回抽脑脊液至2 mL,B组用同等剂量的0.75%布比卡因。观察和记录两组产妇麻醉效应、血流动力学变化、新生儿Apgar评分、术中不良反应和术后恢复情况。结果:R组最高感觉阻滞平面起效时间较B组长(P<0.05);与麻醉前(T_0)比较,两组在注药后5 min(T_1)、10 min(T_2)、15 min(T_3)和20 min(T_4)的SBP、DBP均有下降且B组降低幅度高于R组(P<0.05),B组严重低血压发生率高于R组(31.9%vs.10.9%,P<0.05),两组HR无显著变化(P>0.05);两组新生儿出生1 min Apgar评分无明显差异(P>0.05),R组术中寒战、胸闷、恶心呕吐发生率低于B组(P<0.05),R组术后双下肢肌力恢复至Ⅲ级和肛门首次排气时间均较B组短(P<0.05)。结论:与同等剂量布比卡因相比,罗哌卡因腰-硬联合麻醉用于PIH产妇剖宫产,麻醉效果相同,但对血压影响更小,对新生儿无不利影响,产妇术中不良反应发生率更低,术后恢复更快。

Objective To compare the effects of ropivacaine and bupivacaine in combined spinal-epidural anesthesia for cesarean section with pregnancy induced hypertension（PIH）. Methods 100 pregnant women with PIH, scheduled for cesarean section, were randomly divided into the ropivacaine group （Group R） and the bupivaeaine group （Group B） and received Combined spinal-epidural anesthesia at L3-IA intervertebral space. The Group R were treated with 1.5 mL 0.75 % ropivacaine in 0.5 mL eerebrospinal fluid. The Group B was treated with 0.75 % bupivacaine in the same dose. The anesthesia effects, hemodynamic changes, neonatal Apgar score, in-operation adverse reactions, and postoperative recovery were examined. Results The onset of the highest sensory block levels was later in the Group R than that in the Group B（ P 〈0.05）. Compared to pre anesthesia （TO）, the SBP and DBP of both groups were all decreased at 5 min （T1）, 10 min （T2） , 15 min （T3） , and 20 min （T4） after drug injection, and the magnitude of decrease was more in the Group B than the Group R （P〈0.05）. Incidence of severe hypotension was higher in the Group B than that in the Group R （31.9% vs. 10.9%, P〈0.05）. There were no significant change in IAR or significant difference in neonatal Apgar score at 1 minute after delivery between the two groups. The incidence of shivering, chest distress, nausea and vomiting were lower in the Group R than the Group B （P〈0.05）. The time required for recovery of muscle strength of both lower limbs to Ⅲ was shorter in the Group R than the Group B （P〈0.05）. The first anal exhaust time of the Group R was shorter than that of the Group B（P〈0.05）. Conclusion Both ropivacaine and bupivacaine exhibited the same effects on the combined spinal-epidural anesthesia for cesarean section wsith PIH. Moreover, ropivacaine had less impact on blood pressure and no adverse effects on the newborn, lower incidence of intraoperative adverse reaction, and faster recovery after operation, suggesting that ropivacaine is superior to bupivacaine in Combined Spinal-epidural Anesthesia for Cesarean Section with Pregnancy Induced Hypertension.