重度子痫前期患者剖宫产罗哌卡因腰麻的半数有效剂量

Median effective dose of intrathecal ropivacaine for severe preeclamptic patients undergoing cesarean section

目的测定重度子痫前期患者剖宫产罗哌卡因腰麻的半数有效剂量(ED_(50))。方法拟行剖宫产的重度子痫前期患者及非重度子痫前期的普通孕妇,选择腰3～4穿刺行腰硬联合麻醉,采用序贯法进行测定,腰麻有效时下一个患者下调一级剂量,否则上调一级剂量,罗哌卡因初始剂量为15.625 mg,相邻剂量比为1∶1.25。腰麻有效的标准:蛛网膜下腔给药后15 min内感觉平面不低于T_6,硬膜外未增加任何药物即完成手术。结果重度子痫前期患者剖宫产罗哌卡因腰麻的ED_(50)为11.689 mg,其95%的可信区间CI为(9.983,13.661)mg,与普通孕妇的ED_(50)无差异,2组患者术中不良反应的发生率差异无统计学意义,2组胎儿脐动脉血乳酸的差异有统计学意义。结论腰3～4间隙穿刺时,重度子痫前期患者剖宫产罗哌卡因腰麻的ED_(50)为11.689 mg,95%CI为(9.983,13.661)mg。

Objective To determine the median effective dose (ED50) of intrathecal ropivacaine for severe preeclamptic patients undergoing cesarean section. Methods The pregnant women with and without severe preeclampsia, who were scheduled for cesarean section, were included as the subjects in the study. The combined spinal-epidural anesthesia (CSEA) was performed with puncture at lumbar 3,4 (L3,4) interspace, and the sequential method was used for the measurement. When the spinal anesthesia was effective, the dose would be down-regulated for a level to the next patient, otherwise the dose would be up-regulated for a level. The initial dose of ropivacanine was 15.625 mg, and the ratio of adjacent doses was 1.25. Effective criteria for spinal anesthesia the sensory plane was not lower than T6 within 15 minutes after intrathecal administration, and no supplemental epidural anesthesia was required during the operation. Results The ED50 of intrathecal ropivacaine for severe preeclamptic patients undergoing cesarean section was 11.689 mg, and the 95% confidence interval (CI) was (9.983,13.661)mg. There was no difference in the ED50 between the pregnant women with and without severe preeclampsia. There was no statistically significant difference in the incidence of adverse reactions between the two groups, whereas the difference in fetal umbilical arterial blood lactate between the two groups was statistically significant. Conclusion During the puncture at L3,4, the ED50 of intrathecal ropivacaine for severe preeclamptic patients undergoing cesarean section is 11.689 mg,and 95%CI is (9.983,13.692)mg.