罗哌卡因重比重液蛛网膜下腔阻滞在高原地区剖宫产术中的麻醉应用

Application of subarachnoid block with hyperbaric ropivacaine in cesarean section at plateau area

目的分析高原地区剖宫产手术罗哌卡因重比重液蛛网膜下腔阻滞的临床效果和可行性。方法高原地区60例行剖宫产手术的患者随机分为蛛网膜下腔阻滞麻醉(SA)组30例和硬膜外麻醉(EA)组30例。2组患者均选择腰椎(L)_(2~3)间隙进行硬膜外穿刺,SA组26 G腰麻穿刺针穿入蛛网膜下腔后注入0.75%罗哌卡因(耐乐品)1.5 ml和10%葡萄糖1 ml重比重液,EA组采用2%利多卡因麻醉。观察并记录2组患者的麻醉起效时间,手术开始时间、麻醉效果及麻醉前、手术中及手术后无创血压的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))变化,新生儿娩出后Apgar评分及不良事件发生率等。结果SA组麻醉起效时间、手术开始时间均明显短于EA组(P<0.05)。2组在麻醉起效短时间内血压均有下降,SA组血压下降幅度大于EA组(P<0.05)。麻醉优良率、2组新生儿Apgar评分及不良事件发生率差异无统计学意义(P>0.05)。结论罗哌卡因重比重液SA在高原环境下应用于剖宫产手术是安全可行的。麻醉起效快,手术开始时间短,麻醉效果好。

Objective To analyze the clinical effect and feasibility of subarachnoid block(SA)with hyperbaric solution of ropivacaine in cesarean section at plateau area.Methods Sixty patients scheduled for routine cesarean sections at the plateau area were randomly divided into SA group and epidural block(EA)group(n=30),In group SA,1.5 ml 0.75%ropivacaine mixed in 1 ml 10%glucose were injected into subarachnoid space after lumber puncture success by 26G needle,and in group EA 2%lidocaine was injected into epidural space.The onset time of anesthesia and surgery,anesthesia effect and mean arterial pressure(MAP),heart rate(HR),Apgar score of neonate and adverse events were observed and recorded in both groups.Results The onset time of anesthesia and surgery in the group SA were significantly shorter than those in the group EA(P<0.05).Both groups had a decrease in MAP at the early time of anesthesia,and the MAP in group SA was lower than that in group EA(P<0.05).There was no significant difference in effect rate of anesthesia,Apgar score of neonates,and adverse events between the two groups(P>0.05).Conclusion SA with hyperbaric solution of ropivacaine is safe and feasible in plateau area for cesarean section.It can shorten onset time of anesthesia and surgery,and make the anesthesia effect good.