罗哌卡因用于腰硬联合麻醉在剖宫产术中临床研究.docVIP

罗哌卡因用于腰硬联合麻醉在剖宫产术中临床研究 　　摘 要目的：探讨罗哌卡因用于腰- 硬联合麻醉在剖宫产术的临床效果及安全性。方法：选择ASAⅠ～Ⅱ级足月妊娠初产妇120例, 随机双盲法分为两组,每组各60 例。罗哌卡因组(A 组) : 0.75%罗哌卡因2ml + 10%葡萄糖液0.5 ml；布比卡因组(B组) :0.75 %布比卡因1.25 ml + 10 %葡萄糖液1.25 ml 分别配成重比重混合液。术中麻醉效应不足时经硬膜外导管补充2 %利多卡因。术中连续监测生命体征，比较感觉、运动阻滞情况、麻醉效果评价, 观察围手术期不良反应的发生和Apgar评分。结果：B组感觉阻滞起效快, 感觉阻滞最高平面固定所需时间短,与A组比差异有统计学意义(P 0.05)，最大感觉阻滞平面和感觉恢复时间无明显差异，两组下肢最大阻滞程度(采用改良Bromage评分) ,评分差异有统计学意义(P 0.01) , 运动恢复时间A组短于B组(P 0.05)。两组均有不同程度的血压下降, B组低血压的发生率明显高于A组(P0.05)。结论：重比重罗哌卡因用于腰麻- 硬膜外联合麻醉在剖宫产术中安全有效。与布比卡因相比, 罗哌卡因对下肢运动阻滞弱且恢复迅速，对心血管的影响小。 　　关键词罗哌卡因；布比卡因；腰麻- 硬膜外联合麻醉；剖宫产 　　 　　AbstractObjective：To investigate the efficacy and safety of ropivacaine and bupivacaine for combined spinal - epidural anesthesia (CSEA) for caesarean section. Methods：One hundred twenty primiparae (ASAⅠ～Ⅱ) scheduled for selective caesarean sectionwere divided into two groups randomly with 60 cases each. Ropivacaine group (R) received 2 ml of 0.75 % ropivacaine with 0.5 ml of 10 % glucose ；bupivacaine group (B)received 1.25 ml of 0.75 % bupivacaine with 1.25 ml of 10 % glucose. The patients that spinal anaesthesia was poorneeded additive 2 % lidocaine via epidural catheter . Blood pressure , heart rate and spo2 were recorded. Sensory and motor block , the efficacy of anesthesia , and side effects were recorded. Results： There was no significant difference among the two groups in the efficacy , the height of block ,the recovery time of sensory block (P0.05) ,but the onset time was later and duration of block shorter in ropivacaine group (P0.05) . Motor block was weaker with ropivacaine than that with bupivacaine (P0.05).Hemodynamics side effects were weaker in ropivacaine group.Conclusions：Hyperbaric ropivacaine could lead to a good anesthesia effect and fast motor recovery when used in CSE anesthesia for Cesarean Section than that with bupivacaine, and more stable hemodynamic status. 　　Key wordsropivacaine；bupivacaine；combined spinal- epidural anesthesia；caesarean section 　　 　　新型酰胺类局麻药,罗哌卡因的蛋白结合率高,脂