0.75%罗哌卡因用于剖宫产手术硬膜外麻醉的研究  

Epidural anesthesia with 0 75% ropivacaine in caesarean section

作　　者：王玲[1] 黄宇光[1] 赵晶[1] 严梅[1] 吴新民[2] 杭燕南[3] 罗爱伦[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院麻醉科,100730 [2]北京医科大学第一医院麻醉科 [3]上海第二医科大学仁济医院麻醉科

出　　处：《中华麻醉学杂志》1999年第6期325-327,共3页Chinese Journal of Anesthesiology

摘　　要：目的　评价０．７５％ 罗哌卡因用于硬膜外麻醉剖宫产手术的临床效果和耐受性，并以０．５％ 丁哌卡因作为对照。方法　择期剖宫产手术病人６１ 例，硬膜外麻醉时随机分别接受０．７５％ 罗哌卡因（Ⅰ组，ｎ＝ ３０）或０．５％ 丁哌卡因（Ⅱ组，ｎ＝ ３１），观察感觉阻滞（针刺法）、运动阻滞（改良Ｂｒｏ－ｍ ａｇｅ评分）、术中疼痛（ＶＡＳ评分）、镇痛和腹壁肌松质量及不良反应。结果　Ⅰ组术前和术中感觉阻滞平面达Ｔ６ 病例的百分比高于Ⅱ组（Ｐ＜ ０．０１），平面达Ｔ６ 的时间短于Ⅱ组（Ｐ＜ ０．０１），最高阻滞平面中位数高于Ⅱ组。Ⅰ组给首剂量后１０ 分钟时出现运动阻滞病例的百分比低于Ⅱ组（Ｐ＜ ０．０５），而３０ 分钟时无明显差异。术后运动阻滞完全恢复时间Ⅰ组明显短于Ⅱ组（Ｐ＜ ０．０５）。Ⅰ组在分娩、子宫缝合、最后缝皮时的疼痛ＶＡＳ评分低于Ⅱ组（Ｐ＜ ０．０５～０．０１），镇痛和腹壁肌松质量优于Ⅱ组（Ｐ＜０．０５～０．０１）。观察中无严重不良反应。结论　０．７５％ 罗哌卡因用于硬膜外麻醉剖宫产手术时其感觉阻滞及镇痛效果优于０．５％ 丁哌卡因，运动阻滞起效较慢而恢复迅速。Objective To evaluate the clinical efficacy and tolerability of 0 75% ropivacaine versus 0 5% bupivacaine in epidural anesthesia in patients undergoing caesarean section Methods Sixty one patients were randomly designed to receive 0 75 ropivacaine (group Ⅰ,n=30))or 0 5% bupivacaine (group Ⅱ,n=31)epidural anesthesia respectively during caesarean section Sensory block (pinprick),motor block (modified Bromage scale),intraoperative pain(VAS score),quality of anlge sia and abdominal wall relaxation were assessed together with adverse event Results The percent age of sensory block to T 6 level was higher and onset of sensory block to T 6 was shorter in group Ⅰ than those in group Ⅱ(P<0 01),the median of maximum cephalad sensory spread was higher with ropivacaine than with bupivacaine;Although the incidence of motor block did not differ between the groups 10min after the main dose,but a significantly lower incidence was found 30min after the main dose,and duration of complete recovery from motor block was shorter with ropivacaine than with bupivacaine (P<0 05) Significantly lower pain scores were observed at delivery,exteriorization and at last suture,and the quality of analgesia and abdominal wall relaxation were better in group Ⅰ than those in group Ⅱ(P<0 05 0 01) No severe adverse event was found during the observa tions Conclusion 0 75% ropivacaine provides a better sensory block and intraoperative analgesia than 0 5% bupivacaine when used epidurally in patients undergoing caesarean section,and the onset of motor block is slower and the recovery from motor block is faster with 0 75% ropivacaine

关 键 词：罗哌卡因 布比卡因 硬膜外麻醉 剖腹产 

分 类 号：R719.8[医药卫生—妇产科学] R614.4[医药卫生—临床医学]