不同剂量罗哌卡因等比重腰麻-硬膜外联合阻滞对母婴肾素活性、血管紧张素Ⅱ及醛固酮系统的影响

Effect of combined spinal epidural anesthesia with different doses of ropivacaine on maternal and child RAAS system in cesarean section

目的探讨剖宫产术中不同剂量罗哌卡因等比重腰麻-硬膜外联合麻醉对母婴肾素活性(PRA)、血管紧张素Ⅱ及醛固酮(RAAS)系统的影响。方法选取安吉县妇幼保健院2015年6月至2017年4月行剖宫产手术的产妇140例为研究对象,产妇术中均采用罗哌卡因等比重腰麻-硬膜外联合麻醉方式,并按罗哌卡因用药剂量的不同分为A组(8 mg)、B组(10 mg)、C组(12 mg)、D组(15 mg)四组,每组35例。比较四组镇痛效果、各时间段内母婴RAAS系统中各指标变化情况。结果所有胎儿顺利娩出。四组镇痛效果相比,A组麻醉镇痛效果Ⅳ级的产妇比例最低,为17.14%(6/35),B、C两组比例相似,分别为42.86%(15/35)、45.71%(16/35),D组所占比例最高,为71.42%(25/35),D组麻醉镇痛效果Ⅳ级产妇所占比例明显优于A、B、C三组,差异均有统计学意义(χ^2=20.90、5.83、4.77,均P<0.05)。A组各时间段内PRA水平无明显改变;B、C、D组T1~T3时间段内PRA水平均明显低于T0(t=14.64、37.04、3.97、15.34、29.93、4.73、25.83、33.00、5.23、12.47、8.94、5.96,均P<0.05)。A组T1~T3时间段内血管紧张素Ⅱ(AT-Ⅱ)虽下降,但与T0相比差异无统计学意义;B、C、D组T1~T3时间段内AT-Ⅱ水平均明显低于T0(t=5.95、5.98、3.19、5.86、5.54、4.77、7.96、5.47、6.13,均P<0.05)。A组各时间段内醛固酮(ALD)水平无明显改变;B、C、D组T1~T3时间段内ALD水平均明显低于T0(t=3.75、4.92、2.47、4.08、5.77、2.05、3.94、6.13、3.55,均P<0.05)。胎儿脐动脉、静脉的PRA、AT-Ⅱ和ALD浓度水平均在产妇所测值范围之内。结论10~15 mg的罗哌卡因等比重腰麻-硬膜外联合麻醉时,母婴RAAS系统较为稳定,麻醉及镇痛效果较优。

Objective To investigate the impact of different doses of ropivacaine combined with spinal epidural anesthesia for maternal and neonatal renin activity,angiotensin II and aldosterone in the cesarean section system.Methods From June 2015 to April 2017,140 parturients undergoing cesarean section in the Maternal and Child Health Hospital of Anji County were selected in the research.Combined spinal-epidural ropivacaine were used in all patients during cesarean section anesthesia,and according to different dose of ropivacaine,the patients were divided into A group(8mg),B group(10mg),C group(12mg),D group(15mg),with 35 cases in each group.The analgesic effects of four groups and the changes of each index in the RAAS system of mother and baby in each time period were compared.Results All fetuses were delivered smoothly.Compared the analgesic effect of four groups,the analgesic effect of IV grade in A group was the lowest percentage[17.14%(6/35)],B,C group had similar proportions[42.86%(15/35),45.71%(16/35)],D group had the highest proportion[71.42%(25/35)],the maternal proportion of anesthesia effect of IV grade in D group was significantly better than those in A,B,C group,and the differences were statistically significant(χ^2=20.90,5.83,4.77,all P<0.05).There was no significant change in the level of PRA in each period of A group.The PRA levels in B,C and D group at T1-T3 time were significantly lower than T0(t=14.64,37.04,3.97;15.34,29.93,4.73;25.83,33,5.23;12.47,8.94,5.96,all P<0.05).AT-II in A group at T1-T3 time was decreased,but there was no statistically significant difference compared with T0.AT-II levels in B,C,D group at T1-T3 time were significantly lower than that of T0(t=5.95,5.98,3.19;5.86,5.54,4.77;7.96,5.47,6.13;all P<0.05).No significant changes in ALD level of A group in every period of time;ALD levels in B,C,D group at T1-T3 time period were significantly lower than that of T0(t=3.75,4.92,2.47;4.08,5.77,2.05;3.94,6.13,3.55,all P<0.05).The fetal umbilical artery and vein of PRA,AT-II and ALD concentration were measured in maternal value range.Conclusion When combined with 10-15 mg ropivacaine for combined spinal epidural anesthesia,the RAAS system of mother and baby is more stable,and the effect of anesthesia and analgesia is better.