利多卡因-罗哌卡因两种用药方案对分娩产妇心脏节律的影响  

Effects of lidocaine and ropivacaine on cardiac rhythm of parturient women with two ways of administration

作　　者：翟春春 余奇劲[1] 向晋涛[2] 李华[3] 范翠芳[3] 夏中元[1] ZHAI Chun-chun;YU Qi-jin;XIANG Jin-tao;LI Hua;FAN Cui-fang;XIA Zhong-yuan(Department of Anesthesiology,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Department of Cardiology,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Obstetrics Department,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院麻醉科,湖北武汉430060 [2]武汉大学人民医院心内科,湖北武汉430060 [3]武汉大学人民医院产科,湖北武汉430060

出　　处：《中国心脏起搏与心电生理杂志》2020年第4期365-369,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨利多卡因-罗哌卡因两种用药方案对分娩产妇心脏节律的影响。方法选取产科2019年7月至2019年11月份足月待产初产妇,根据分娩方式不同,连续选取剖宫产(剖宫组)、经阴道自然分娩(自然组)、分娩镇痛阴道分娩(镇痛组)各20例。剖宫组和镇痛组均采用硬膜外穿刺置管麻醉,两组平卧后均给予2%的利多卡因3 ml,观察5 min,如无不适,剖宫组再给予2%的利多卡因7~10 ml,调控麻醉水平在T6~T8,后续按需采用0.75%罗哌卡因维持麻醉;镇痛组给予0.1%罗哌卡因初始剂量8~10 ml,持续输注量6~8 ml/h,锁定15 min,自控给药2 ml,调控麻醉在T10水平。在孕产妇分娩期间采用单导24 h动态心电图记录仪记录长程心电图,采用时间RR间期(t-RR)散点图及逆向技术分析胎儿分娩前后的心电指标及心率变异性(时域),截屏记录分娩前后各1 h(共2 h)的t-RR散点图,观察其分娩前后的曲线变化。结果三组孕产妇分娩后t-RR散点图曲线均变为平直形;剖宫组分娩前t-RR散点图曲线为不规则的大波浪形或平直形;而镇痛组和自然组分娩前均为正或余弦波曲线;与剖宫组比较,自然组分娩前后的室性早搏发生例数均增多(6/20 vs 0;5/20 vs 0;P<0.05)。与剖宫组比较,镇痛及自然组最快、平均心率变快(P<0.05或0.01)。而自然组分娩后的最慢心率快于剖宫组[(74±14)次/分vs (61±9)次/分,P<0.05]。三组心率变异性时域比较整体没有显著性差异。结论利多卡因-罗哌卡因硬膜外镇痛对自然分娩前后的RR间期变化趋势没有明显影响;满足手术需求量的麻醉药物对分娩前后的室性早搏有明显抑制作用;这些作用可能与疼痛无关。Objective To explore the effect of lidocaine and ropivacaine on cardiac rhythm of parturient women with two ways of administration and its possible mechanism. Methods From July 2019 to November 2019, the cases of cesarean section(cesarean section group,n=20), vaginal delivery(natural Group,n=20) and vaginal delivery with labor analgesia(analgesia group,n=20) were selected consecutively according to different modes of delivery. In the cesarean section group and the analgesia group, epidural anesthesia was used, and 2% lidocaine 3 ml was given to both groups after lying on their back. After 5 minutes of observation, if there was no discomfort, another 2% lidocaine 7-10 ml was given to the cesarean section group to regulate the anesthesia level in T6-T8, and then 0.75% ropivacaine was used to maintain the anesthesia as required;In the analgesia group, the initial dose of 0.1% ropivacaine was 8-10 ml, the continuous infusion volume was 6-8 ml/h,the analgenia pump with a 2 ml bolus could be controlled by parturient women with a 15 min interval, and the anesthesia was controlled at T10 level. During the period of delivery, the long-range electrocardiograph(ECG) was recorded by single lead 24 h dynamic ECG. The ECG indexes and heart rate variability(time domain) before and after delivery were analyzed with time RR interval(t-RR) scatter plot and reverse technology. The t-RR scatter plot of 1 h before and 1 h after delivery were shown by screen capture,and the curve changes before and after delivery were observed. Results In the three groups,the t-RR curve became straightafter delivery;in the cesarean section group,the t-RR curve was irregular large wave or straight before delivery;in the analgesia group and the natural group,the t-RR curve was sine or cosine wave before delivery;Compared with the cesarean sectiongroup,the number of cases of ventricular premature beat in the natural group increased before and after delivery(6/20 vs 0;5/20 vs 0;P<0.05).Compared with the cesarean section group,the fastest and the average h

关 键 词：心血管病学 麻醉学 利多卡因 罗哌卡因 分娩 心电现象 

分 类 号：R540.41[医药卫生—心血管疾病]