血压正常产妇和重度子痫前期产妇剖宫产鞘内罗哌卡因ED_(50)比较

ED_(50) of ropivacaine for cesarean delivery under spinal in normotensive and severe preeclamptic puerperas

目的比较血压正常产妇和重度子痫前期产妇剖宫产罗哌卡因腰麻的半数有效量(ED_(50))。方法选择6 0例血压正常产妇(N组)和6 0例重度子痫前期产妇(P组),ASA分级为Ⅰ级或Ⅱ级,将每组患者均分为4小组(N1、N2、N3、N4,P1、P2、P3、P4),每小组15例,相应各组鞘内剂量分别为21、19、17及15 mg的罗哌卡因。选择L3~L4行腰硬联合穿刺,5 min后记录麻醉平面。麻醉有效标准:麻醉平面≥T6;术中患者无痛。无效标准:麻醉平面不能达到T6或术中患者疼痛。根据结果进行Probit分析,计算两组患者罗哌卡因腰麻的ED_(50)和ED9 5。观察各组术中及术后不良反应以及新生儿的Apgar评分和脐动脉p H。结果N组ED_(50)为15.449(95%CI,15.293~1 6.2 6 8),ED9 5为16.857(95%CI,15.971~16.965);P组ED_(50)为15.987(95%CI,15.492~16.809),ED9 5为1 7.3 9 5(9 5%CI,1 5.4 9 8~1 7.5 4 8)。两组ED_(50)比较,差异无统计学意义(P>0.05)。N1、N2,P1、P2组低血压的发生率高于其他各组,差异有统计学意义(P<0.05);其他不良反应发生率比较,差异无统计学意义(P>0.05)。两组患者胎儿脐动脉血p H比较,差异有统计学意义(P<0.05)。结论重度子痫前期产妇剖宫产腰麻罗哌卡因剂量与血压正常产妇接近。

Objective To determine the ED50 of intrathecal hyperbaric ropivacaine for normotensive and severe preeclamptic puerperas undergo elective cesarean delivery. Methods 60 ASA physical I or II normotensive puerpera（ group N） and 60 pre- eclamptic puerperas（group P） were selected. All patients in each group were divided into 4 groups again （NI, N2, N3, N4, P1, P2, P3, P4）, 15 cases in each group. Intrathecal hyperbaric bupivaeaine was administrated to each group, and the dose of each group was 21, 19, 17, 15 mg respectively. Combined spinal/epidural bloek was performed at L3 - L4 interspace. The block was recorded after 5 minutes. Effective standard： the block reached at T6 or higher and patient feel no pain during surgery. Inva- lid standard： the block failed to reach at T6 or there was breakthrough pain during surgery. According to the results, ED50 and ED95 of ropivaeaine were calculated by probit analysis for the two groups. Intraoperative and postoperative eomplieations were ob-served. The neonatal Apgar score and umbilical arterial pH were recorded. Results The ED50 of group N was 15.449 （95% CI, 15. 293 - 16. 268）, and the ED95 was 16. $57（95% CI, 15. 971 - 16. 965）. The ED50 of group P was 15. 987（95% CI, 15. 492 - 16. 809）, and the ED95 was 17. 395 （95% CI, 15. 498 -17. 548）. There was no significant difference in EDso between two groups （P 〉 0. 05 ）. The incidence of hypotension of group N1, N2, P1 and P2 than other groups, and the difference was statisti- cally significant （P 〈 0. 05 ）. There was no significant difference in other side - effects among the groups （ P 〉 0.05 ）. There was a significant difference in fetal umbilical arterial pH between two groups （ P 〈 0. 05 ）. Conclusion The dose of intrathecal hyper- baric bupivacaine is similar to normotensive puerperas when severely preeclamptic puerperas undergo elective cesarean delivery.