硬膜外穿刺置管对剖宫产患者罗哌卡因蛛网膜下腔麻醉效果的影响

Effect of epidural catheterization on ropivacaine subarachnoid anesthesia in patients undergoing cesarean section

目的探讨硬膜外穿刺置管对剖宫产产妇罗哌卡因蛛网膜下腔麻醉效果的影响。方法选择2016年9月至2017年8月山西医学科学院山西大医院妇产科收治的初产单胎足月妊娠行剖宫产孕妇90名,应用随机数字表法分为3组:单纯蛛网膜下腔麻醉组(D,组)、硬膜外穿刺不置管组(D_2组)、脊椎-硬膜外联合麻醉组(D_3组),每组30例。比较3组产妇达感觉阻滞平面时间及恢复阻滞平面时间、产妇运动阻滞评分和运动阻滞起效及恢复时间以及产妇疼痛程度、腹肌松弛程度和牵拉反应程度。结果 D_3组达双侧肋弓下缘连线平面、胸骨剑突平面和最高阻滞平面时间均短于D_1、D_2组[(1.8±0.3)min比(2.5±0.5)、(2.3±0.4)min,(2.2±0.4)min比(3.0±0.4)、(2.8±0.6)min,(2.3±0.3)min比(3.2±0.6)、(3.0±0.4)min],恢复至双侧肋弓下缘连线平面、肚脐平面时间均短于D_1、D_2组[(70±9)min比(85±11)、(80±12)min,(85±4)min比(105±9)、(100±8)min],差异均有统计学意义(均P<0.05)。3组产妇运动阻滞评分和运动阻滞起效时间、达最大运动阻滞起效时间、运动阻滞恢复时间以及产妇疼痛程度、腹肌松弛程度和牵拉反应程度比较差异均无统计学意义(均P>0.05)。结论单纯硬膜外穿刺置管可缩短剖宫产产妇罗哌卡因的感觉阻滞时间,但不影响运动阻滞时间和临床麻醉效果。

Objective To explore the effect of epidural catheterization on ropivacaine subarachnoid anesthesia in patients undergoing cesarean section. Methods A total of 90 pregnant women undergoing cesarean section from September 2016 to August 2017 in Shanxi Dayi Hospital, Shanxi Academy of Medical Sciences were randomly divided into 3 groups（n=30）： simple subarachnoid anesthesia group（D1 group）, epidural puncture without catheterization group（D2 group） and combined spinel epidural anesthesia group（D3 group）. Sensory block time, sensory recovery time, motor block score, motor block time, motor block recovery time, pain degree, abdominal muscle relaxation degree and traction reaction degree were analyzed. Results T8, T6 sensory block time and the maximum sensory block plane time in D3 group were significantly shorter than those in D1, D2 group［（1.8±0.3）min vs （2.5±0.5）,（2.3±0.4）min; （2.2±0.4）min vs （3.0±0.4）,（2.8±0.6）min; （2.3±0.3）min vs （3.2±0.6）,（3.0±0.4）min］; T8, T10 sensory recovery time in D3 group were significantly shorter than those in D1, D2 group［（70±9）min vs（85±11）,（80±12）min; （85±4）min vs（105±9）,（100±8）min］（all P〈0.05）.Motor block score, motor block time, the maximum motor block plane time, motor block recovery time, pain degree, abdominal muscle relaxation degree and traction reaction degree showed no significant differences among 3 groups（P＞0.05）. Conclusion Epidural catheterization may shorten sensory block time of ropivacaine in cesarean section, but it does not affect motor block time and the anesthesia effect.