等比重罗哌卡因脊椎麻醉在子痫前期剖宫产手术中的应用  

Clinical observation of isobaric ropivacaine for spinal anesthenia used in preeclampsia cesarean section

作　　者：张蕊霞 赵学军 张琳玲 温海燕 ZHANG Rui-xia;ZHAO Xue-jun;ZHANG Lin-ling;WEN Hai-yan(Department of Anesthesiology, Shanghai Songjiang District Maternal and Child Health Hospital Shanghai 201620;Shanghai Songfiang District Commission of Health and Family Planning, Shanghai 201620, China)

机构地区：[1]上海市松江区妇幼保健院麻醉科,上海201620 [2]上海市松江区卫生和计划生育委员会,上海201620

出　　处：《世界临床药物》2018年第6期407-411,共5页World Clinical Drug

摘　　要：目的探讨0.5%盐酸罗哌卡因等比重液脊椎麻醉(SA)在子痫前期剖宫产手术麻醉中应用的安全性及其优势。方法纳入我院子痫前期拟择期行剖宫产手术的产妇120例作为研究对象,随机分为脊椎麻醉组(SA组)和连续硬膜外麻醉组(CEA组),每组各60例。均选择腰椎_(2-3)(L_(2-3))间隙作为穿刺点,其中SA组选择0.5%盐酸罗哌卡因13~14 mg(2.6~2.8 ml)注入蛛网膜下腔,CEA组行硬膜外阻滞,用2%利多卡因测麻醉平面存在后,根据手术需要给予0.75%盐酸罗哌卡因原液15~20 ml。观察并记录两组产妇入室后(T_0)、手术划皮前(T_1)、胎儿娩出时(T_2)、关腹时(T_3)和手术结束时(T_4)血压和心率,以及最高感觉运动阻滞平面、麻醉效果、改全麻例数、不良反应发生率、新生儿娩出后1、5 min Apgar评分及脐动脉血p H值。结果两组各手术时间点(T_1~T_4)血压较麻醉前(T_0)均有不同程度下降(P<0.05),SA组SBP及最低值下降程度较CEA组小(P<0.05);SA组最高感觉运动阻滞平面低于CEA组(P<0.05),SA组麻醉效果分级达Ⅳ级多于CEA组(P<0.05),CEA组有5例改全麻完成手术;两组不良反应发生率、新生儿娩出后1、5 min Apgar评分及脐动脉血p H值比较差异无统计学意义(P>0.05)。结论 0.5%盐酸罗哌卡因等比重液SA效果更好,术中、术后不良反应少,对胎儿无影响,用于子痫前期产妇的剖宫产麻醉是安全有效的。Objective To observe the advantage and safety of isobaric 0.5% ropivacaine hydrochloride for the spinal anesthesia（SA） used in preeclampsia cesarean section. Methods A total of 120 patients with the preeclampsia undergoing cesarean section were randomly divided into two groups as 60 each group. Both groups were punctured in L（2-3） interspace, then one group was given SA（SA group） and the other was given continuous epidural anesthesia（CEA group）. The patients of SA group received intrathecal isobaric 0.5% ropivacaine hydrochloride 13-14 mg, and the patients of CEA group received 2% liduocaine 4 ml and 0.75% ropivacaine 15-20 ml. The HR and BP were respectively recorded in the following five time points： entering surgery room（T0）, skin incision（T1）, mean time for fetal delivery（T2）, close abdomen（T3） and surgery ending（T4）. The anesthesia effect, the sensory and motor block level, the case of general anesthesia, the incidence of adverse drug reactions, the neonatal Apgar score and the umbilical artery blood＇s p H value were observed. Results Compared with T0, the BP of two groups at each time point（T1-T4） was decreased in varying degrees（P〈0.05）. The SBP and its absolute minimum of CEA group were decreased significantly compared with SA group（P〈0.05）. The maximum sensory and motor block level of SA group was lower than that of CEA group（P〈0.05） and SA group had better anesthesia effect than CEA group（P〈0.05）. The incidence of adverse drug reactions, the Apgar score of the neonate after delivery 1 min, 5 min and the umbilical artery blood＇s p H value showed no significant difference（P〉0.05）. Conclusion The SA with isobaric 0.5% ropivacaine hydrochloride used for preeclampsia cesarean section anesthesia has good advantage and less adverse drug reactions.

关 键 词：罗哌卡因 等比重液 脊椎麻醉 子痫前期 剖宫产 

分 类 号：R544.1[医药卫生—心血管疾病] R719.8[医药卫生—内科学]