剖宫产术中硬膜外容量扩张对罗哌卡因腰麻最小有效剂量的影响  

Effect of epidural volume dilation on the minimum effective dose of ropivacaine for spinal anesthesia during cesarean section

作　　者：于浏 钱兴华 YU Liu;QIAN Xing-hua(Department of Anesthesiology,Jiaxing Maternal and Child Health Hospital,Jiaxing 314000,China;Department of Anesthesiology,Affiliated Children's Hospital of Zhejiang University,Hangzhou 310003,China)

机构地区：[1]嘉兴市妇幼保健院麻醉科,浙江嘉兴314000 [2]浙江大学附属儿童医院麻醉科,浙江杭州310003

出　　处：《实用药物与临床》2019年第11期1152-1155,共4页Practical Pharmacy and Clinical Remedies

摘　　要：目的探讨剖宫产术中硬膜外生理盐水扩张对重比重罗哌卡因腰麻最小有效剂量(ED50)的影响。方法60例足月单胎初产妇随机分为2组,每组30例。观察组在鞘内给药后硬膜外给予10 ml生理盐水,对照组未给任何液体。罗哌卡因初始剂量为10 mg,有效剂量定义为鞘内给药后10 min采用针刺时双侧感觉阻滞平面达到T6并且不用硬膜外加药完成手术。根据上一例产妇的镇痛效果,上调或下调下一例产妇罗哌卡因的剂量,浓度梯度为1 mg。观察两组腰麻起效时间和作用持续时间,记录血压、心率及母婴相关并发症;采用Probit回归分析计算罗哌卡因的ED50及95%CI。结果观察组重比重罗哌卡因腰麻的ED50为7.51 mg(95%CI:7.09~7.93 mg),对照组为8.29 mg(95%CI:7.73~8.85 mg),两组比较差异有统计学意义(P<0.05)。结论在剖宫产术中,硬膜外生理盐水容量扩张时重比重罗哌卡因腰麻的ED50为7.51 mg,且硬膜外生理盐水容量扩张能使其降低。Objective To investigate the effect of epidural saline dilation on the minimum effective dose(ED50)of ropivacaine for spinal anesthesia in cesarean section.Methods Sixty full-term single primipara were randomly divided into two groups with 30 cases in each group.Observation group was given 10 ml saline after intrathecal administration,while control group was not given any liquid.The initial dose of ropivacaine was 10 mg,and the effective dose was defined as the bilateral sensory block level reaching T6 at 10 minutes after intrathecal administration and the operation being completed without epidural administration.According to the analgesic effect of the previous puerpera,the dose of ropivacaine in next puerpera was increased or decreased with a concentration gradient of 1 mg.The onset time and duration of lumbar anesthesia were observed,and the blood pressure,heart rate and maternal-infant complications were recorded,then the ED50 and 95%CI of ropivacaine were calculated by Probit regression analysis.Results The ED50 of ropivacaine for spinal anesthesia was 7.51 mg(95%CI:7.09~7.93 mg)in observation group and 8.29 mg(95%CI:7.73~8.85 mg)in control group.There was a significant difference between the two groups(P<0.05).Conclusion In cesarean section,the ED50 of ropivacaine for spinal anesthesia is 7.51 mg when the volume of epidural saline dilates,and the volume dilation of epidural saline can reduce it.

关 键 词：罗哌卡因 剖宫产 腰麻 量效关系 

分 类 号：R61[医药卫生—外科学]