根据脊柱长度确定罗哌卡因剂量用于腰麻剖宫产效果

FEASIBILITY OF DETERMINING ROPIVACAINE DOSE BASED ON THE LENGTH OF THE SPINE FOR SPINAL ANESTHESIA IN CESAREAN SECTION

目的探讨剖宫产腰麻实施过程中根据脊柱长度确定罗哌卡因剂量的可行性。方法择期行剖宫产手术病人60例,随机分为观察组(R组)和对照组(C组),每组30例。R组根据脊柱长度计算罗哌卡因剂量,C组根据临床经验用药,均用脑脊液稀释配制腰麻液3.0 mL进行腰麻。观察感觉、运动阻滞起效时间,最高阻滞平面及最高阻滞平面阻滞时间;评定麻醉效果;记录麻醉后平均动脉压(MAP)及心率;观察术中低血压、恶心呕吐及术后头痛等不良反应发生情况。结果两组感觉、运动阻滞起效时间及最高阻滞平面阻滞时间比较,差异均无统计学意义(P>0.05);R组最高阻滞平面低于C组(t=6.88,P<0.05)。两组麻醉效果比较差异无显著性(P>0.05)。麻醉后R组循环更稳定,MAP明显高于C组(t=15.96,P<0.05)。R组给药后恶心呕吐发生率明显低于C组(χ2=4.81,P<0.05)。结论剖宫产腰麻实施过程中根据脊柱长度确定罗哌卡因剂量,麻醉用药更精准,效果满意,产妇术中血流动力学稳定,不良反应更少。

Objective To investigate the feasibility of determining ropivacaine dose based on the length of the spine during the implementation of spinal anesthesia for cesarean section. Methods A total of 60 patients undergoing selective cesarean section were randomly divided into observation group（group R）and control group（group C）,with 30 patients in each group.The dose of ropivacaine was determined based on the length of the spine for group R,while the dose of ropivacaine was determined based on clinical experience in group C.Spinal anesthesia was performed with 3.0 mL diluted cerebrospinal fluid.The onset time of sensory and motor block was observed,as well as the highest block level and the time to the highest level of block.The anesthetic outcome was evaluated;mean arterial pressure（MAP）and heart rate were recorded after anesthesia;the incidence of intraoperative hypotension,nausea,vomiting,and postoperative headache was observed. Results There were no significant differences in the onset time of sensory and motor block and the time to the highest level of block between the two groups（P〈0.05）,and group R had a significantly lower highest block level than group C（t=6.88,P〈0.05）.There was no significant difference in anesthetic outcome between the two groups（P〈0.05）.The patients in group R had stable circulation after anesthesia and had significantly higher MAP than those in group C（t=15.96,P〈0.05）.Group R had significantly lower incidence rates of nausea and vomiting than group C（χ2=4.81,P〈0.05）. Conclusion During the implementation of spinal anesthesia for cesarean section,the dose of ropivacaine determined based on the length of the spine can achieve an accurate dose,a satisfactory outcome,and stable hemodynamics during surgery,with few adverse events.