罗哌卡因与布比卡因用于下腹部手术脊麻的效果观察(精选).docVIP

罗哌卡因混合舒芬太尼用于剖宫产手术硬膜外麻醉的效果观察 郑 红 （天津河西医院麻醉科，天津 300200） 中图分类号：R5 文献标识码： 文章编号： 摘要：目的 比较0.75％罗哌卡因混合舒芬太尼与0.75％罗哌卡因用于剖宫产手术患者硬膜外麻醉的临床效果。方法 择期剖宫产手术患者40例，ASA I级，随机分为2组（n＝20）：S组（舒芬太尼＋罗哌卡因组），R组（罗哌卡因组）。选择L2-3间隙穿刺，将药液注入硬膜外腔。记录感觉阻滞的起效时间，持续时间，最高阻滞平面及达最高阻滞平面的时间，运动阻滞的起效时间，持续时间，术中疼痛程度，腹肌松弛程度，牵拉反应程度及不良反应的发生和处理。结果 S组感觉阻滞起效时间及达最高平面的时间短于R组，持续时间延长最高平面升高，两组下肢运动阻滞的起效时间，持续时间及评分比较差异无统计学意义（P 0.05），S组牵拉反应程度低于R组，S组恶心呕吐的发生率高于R组，（P 0.01）。结论 剖宫产手术患者混合舒芬太尼可增强0.75％罗哌卡因硬膜外麻醉的效果。可以满足剖宫产手术的要求。 【关键词】酰胺类； 舒芬太尼； 硬膜外痲醉； 感觉阻滞； 运动阻滞 A Comparison of Spinal Anesthesia 0.75% Ropivacaine with 0.75% Bupivacaine Used for Lower Abdominal Surgery ZhengHong. Department of Anesthesiology, HeXi hospital , TianJin 300200, China Abstract: Objective To compare the clinical efficacy of spinal 0.75% ropivacaine with 0.75% bupivacaine in patients with lower abdominal surgery. Methods 40 ASA I/II patients were randomly divided into 2 groups n 20 each : group R （the Ropivacaine group and group B（the Bupivacaine group）.Spinal anesthesia was performed at L2-3 interspace .The onset time of sensory block and motor block ,duration of analgesia and motor block were recorded. Hemodynamic, side-effects were also recorded. Results There was no significant difference in sensory block between the two groups P 0.05 .The onset time of motor block was significantly longer in group R than that in group B. The duration of motor block was significantly shorter in group R than that in group B. Conclusion 0.75% ropivacaine can give a satisfactory clinical effective（P 0.01）. The duration of motor block was shorter in group R than that in group B. It is beneficial for patients to recovery quickly. Key word:Ropivacaine; Anesthesia,spinal; Bupivacaine; Sensory block; Motor block 罗哌卡因是酰胺类长效局麻药，是纯s映像体，罗哌卡因对中枢神经系统及心脏的毒性明显低于布比卡因，由于其脂溶性低，低浓度时对运动神经系统的阻滞作用明显弱于对感觉神经的阻滞作用，且对运动神经的阻滞时间明显短于对感觉神经的阻滞时间，从而大大提高了罗哌卡因临床应用的安全性。舒芬太尼是芬太尼的衍生物，因其脂溶性更高，具有鎮痛作用强，持续时间长的特点1。局麻药混合一定剂量的阿片类药可增强硬膜外的镇痛效果。延长镇痛持续时间，从而减轻局麻药的运动神经阻滞作用。本研究旨在观察舒芬太尼混合罗哌