蛛网膜下腔注射罗哌卡因对剖宫产术后患者肺功能的影响  

Effect of ropivacaine administered intrathecally on pulmonary function after caesarean section

作　　者：李文会[1] 耿桂启[1] 孙星峰[1] 黄绍强[1] 

机构地区：[1]复旦大学附属妇产科医院麻醉科,上海市200090

出　　处：《中华麻醉学杂志》2012年第2期164-166,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价蛛网膜下腔注射罗哌卡因对剖宫产术后患者肺功能的影响。方法选择拟行剖宫产术患者36例，ASA分级I或Ⅱ级，年龄22～34岁，体重指数≤35kg／m^2，采用随机数字表法，将患者随机分为2组（n=18）：布比卡因组（B组）和罗哌卡因组（R组）。于L3．4蛛网膜下腔穿刺成功后，B组和R组分别注射0．5％布比卡因1．8ml、1．0％罗哌卡因1．4ml，均用脑脊液稀释至3ml，注药时间10s。于术前1d（To）及蛛网膜下腔给药后1h（T1）、1．5h（T2）、2h（L）时分别测定用力肺活量（FVC）、第1秒用力呼气量（FEV1）以及最大呼气峰流速（PEF），以FVC实测值低于预测值80％且FEV1实测值低于预测值70％为肺功能异常的标准。T1-3时记录运动阻滞评分。结果与T0时比较，两组T1时FVC、FEV，下降，R组T11时PEF下降（P〈0．05）；与T1时比较，两组T2、T3时FVC、FEV。差异无统计学意义（P〉0．05），R组T2，3时PEF升高（P〈0．05）。与B组比较，R组T1时PEF下降，T1时运动阻滞评分降低（P〈0．05）。两组术后均未见肺功能异常发生。结论对无呼吸合并症的剖宫产术患者而言，蛛网膜下腔注射常规剂量罗哌卡因与布比卡因虽然对肺功能指标有一定的抑制作用，但患者肺功能仍维持在正常范围。Objective To investigate the effect of ropivacaine administered intrathecally on the pulmonary function after caesarean section. Methods Thirty-six ASA I or II partttrients, aged 22-34 yr, with body mass index ≤ 35 kg/m2, undergoing elective cesarean section, were randomly divided into 2 groups （n = 18 each）： bupivacaine group （group B） and ropivacaine group （group R）. Spinal anesthesia was performed at L3.4 interspace and 0.5% bupivacaine 1.8 ml （in cerebrospinal fluid 3 ml） and 1.0% ropivacaine 1.4 ml （in cerebrospinal fluid 3 ml） were injected into the subarachnoid space over 10 s in groups B and R respectively. Forced vital capacity （FVC）, forced expiratory volume first second （FEVI） and peak expiratory flow （PEF） were measured by spirometry before surgery （To ）, and at 1, 1.5 and 2 h after intrathecal injection （T1-3）. The motor block score was record- ed at T1-3 It is regarded as the criteria for respiratory dysfunction that the measured values of FVC and FEVI are lower than their 80% and 70% predicted levels respectively. Results FVC and FEV1 were significantly decreased at T1 compared with the baseline value at T0 in both groups （ P 〈 0.05）. Compared with that at T1 , PEF was significantly increased at T2.3 in group R （P 〈 0.05）. Compared with group B, PEF at T1 and motor block score at T3 were significantly decreased in group R （P 〈 0.05） . The respiratory dysfunction was not found in both groups. Conclusion Spinal anesthesia with ropivacaine and bupivacaine can inhibit the parameter level of cady pulmonary function after caesarean section in parturient without respiratory complications, but the pulmonary function still remains normal.

关 键 词：酰胺类 布比卡因 蛛网膜下腔 剖宫产术 呼吸功能试验 

分 类 号：R614[医药卫生—麻醉学]