腰硬联合麻醉罗哌卡因不同应用剂量对剖宫产术中产妇血流动力学与术后疼痛的影响

Effects of different dosages of ropivacaine in spinal epidural anesthesia on hemodynamics and postoperative pain among women undergoing cesarean section

目的 探讨腰硬联合麻醉罗哌卡因不同应用剂量对剖宫产术后产妇血流动力学与疼痛的影响。方法 回顾性分析2021年1月—2023年1月在本院采取剖宫产分娩的100例产妇资料,全部患者剖宫产手术均采取腰硬联合麻醉,根据麻醉中罗哌卡因用量将术中应用2 ml剂量的49例产妇纳入高量组,将术中应用1 ml剂量的51例产妇纳入低量组。比较两组产妇剖宫产术中血流动力学指标:平均动脉压(MAP)、心率(HR)及血气指标:血氧饱和度(SpO_(2)),麻醉质量指标:麻醉起效时间、手术时长、镇痛维持时间、感觉阻滞达最高平面时间、无痛平面时间、麻醉阻滞效果、下肢运动阻滞Bromage评分,术后2 h、6 h、12 h、24 h产妇疼痛程度评分,观察术前、术后1 d两组患者相关临床指标:C反应蛋白(CRP)、纤维蛋白原(FIB)、催乳素(PRL)、血黏度的变化情况。结果 麻醉后15 min、胎儿娩出后、术毕即刻低量组产妇MAP均高于高量组,HR均低于高量组(P<0.05);胎儿娩出后、术毕即刻低量组产妇SpO_(2)均高于高量组(P<0.05);两组产妇麻醉起效时间、手术时长、镇痛维持时间、感觉阻滞达最高平面时间、无痛平面时间、麻醉阻滞效果、下肢运动阻滞Bromage评分均未见统计学差异(P>0.05);两组产妇术后2 h、6 h、12 h、24 h的疼痛程度VAS评分均未见统计学差异(P>0.05);术后,两组产妇CRP、FIB、PRL、血黏度均较本组术前降低,且低量组产妇CRP、FIB、血黏度均低于高量组,PRL高于高量组(P<0.05)。结论 腰硬联合低剂量罗哌卡因不会影响剖宫产产妇的麻醉效果与术后镇痛效果,但产妇术中的血流动力学与血氧饱和度更为平稳,对患者相关术后反应影响更小,低剂量罗哌卡因可在剖宫产手术麻醉中推广应用。

Objective To investigate the effects of different dosages of ropivacaine during combined spinal epidural anesthesia on hemodynamics and pain in postpartum women undergoing cesarean section.Methods A retrospective analysis was conducted on the data of 100 postpartum women who underwent cesarean section in our hospital from January 2021 to January 2023.All patients underwent cesarean section under combined spinal-epidural anesthesia.49 postpartum women who received 2ml of ropivacaine during anesthesia were included in the high-dose group,and 51 postpartum women who received 1ml of ropivacaine during surgery were included in the low-dose group.The hemodynamic indicators including mean arterial pressure(MAP) and heart rate(HR) during cesarean section,blood gas indicators of blood oxygen saturation(SpO_(2)),anesthesia quality indicators(anesthesia onset time,surgical duration,analgesia maintenance time,time for sensory block to reach the highest plane,painless plane time,anesthesia block effect,Bromage score of lower limb motor block),and pain score of postpartum women at 2,6,12,and 24 hours after surgery were compared between two groups of postpartum women.The changes in clinical indicators including C-reactive protein(CRP),fibrinogen(FIB),prolactin(PRL),and blood viscosity in both groups of patients before treatment and at 1 day after surgery were observed.Results The MAP of low-dose group was higher than that in the high dose group at the time points 15 minutes after anesthesia,after fetal delivery,and immediately after surgery,while HR was lower than the high dose group(P<0.05).After fetal delivery and immediately after surgery,the SpO_(2) of the low dose group was higher than that of the high dose group(P<0.05).There were no statistically significant difference in the onset time of anesthesia,surgical duration,duration of analgesia,time of reaching the highest level of sensory block,time of painless level,anesthesia block effect,and lower limb motor block Bromage score between the two groups of postpartum women(P>0.05).There were no statistically significant differences in VAS scores of pain levels between the two groups of postpartum women at 2,6,12,and 24 hours after surgery(P>0.05).After surgery,the CRP,FIB,PRL,and blood viscosity of the two groups of postpartum women decreased compared to those before surgery,and the CRP,FIB,and blood viscosity of the low dose group were lower than those of the high dose group,while the PRL was higher than that of the high dose group(P< 0.05).Conclusions The low-dose ropivacaine during combination of lumbar epidural anesthesia does not affect the anesthesia and postoperative analgesic effects of cesarean section women,but the hemodynamics and blood oxygen saturation during the operation are more stable,and the impact on related postoperative reactions is smaller.Low dose ropivacaine can be promoted and applied in manual anesthesia for cesarean section.