罗哌卡因与布比卡因在剖宫产腰硬联合麻醉中的疗效及安全性比较  

Comparison of efficacy and safety of ropivacaine and bupivacaine in combined spinal epidural anesthesia for cesarean section

作　　者：罗显刚 肖倩兰 LUO Xiangang;XIAO Qianlan(Department of Anesthesiology,Huanggang Maternal and Child Health Hospital,Hubei Province,Huanggang 435000,China)

机构地区：[1]湖北省黄冈市妇幼保健院麻醉科,435000

出　　处：《临床合理用药杂志》2021年第26期34-36,共3页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的 比较罗哌卡因与布比卡因在剖宫产术麻醉中的效果及安全性。方法 回顾性分析2019年3月-2020年6月于黄冈市妇幼保健院行剖宫产术分娩的产妇200例临床资料,根据术中麻醉用药不同分为罗哌卡因组和布比卡因组,各100例。比较2组产妇麻醉效果,感觉神经与运动神经麻醉起效和恢复时间,麻醉前5 min、麻醉后5 min、麻醉后10 min时血流动力学[心率(HR)、平均动脉压(MAP)]指标及不良反应(恶心呕吐、低血压、头痛及心动过缓)发生情况。结果 2组产妇麻醉优良率比较差异无统计学意义(P>0.05);罗哌卡因阻断感觉神经和运动神经的阻滞起效时间均长于布比卡因组(P<0.01);2组感觉神经恢复时间比较差异无统计学意义(P>0.05),罗哌卡因组运动神经恢复时间短于布比卡因组(P<0.01);2组产妇MAP和HR均表现为先降后升,2组各时点MAP比较差异均无统计学意义(P>0.05),罗哌卡因组麻醉后5 min、麻醉后10 min时HR均高于布比卡因组(P<0.01);罗哌卡因组麻醉不良反应总发生率为4. 0%,低于布比卡因组的12.0%(χ^(2)=4. 348,P=0. 037)。结论 罗哌卡因与布比卡因应用于剖宫产术腰硬联合麻醉中均能获得满意的麻醉效果,但罗哌卡因对产妇术中血流动力学的干扰更小,安全性更高,术后运动神经功能恢复更快,值得临床推广应用。Objective To compare the application effect and safety of ropivacaine and bupivacaine in cesarean section anesthesia.Methods The clinical data of 200 cases of cesarean delivery in Huanggang Maternal and Child Health Hospital from March 2019 to June 2020 were retrospectively analyzed.They were divided into ropivacaine group and Bupivacaine group according to different anesthetic drugs,100 cases in each group.The anesthesia effect,the onset and recovery time of sensory nerve and motor nerve anesthesia,hemodynamic(HR,MAP)indexes and adverse reactions(nausea and vomiting,hypotension,headache and bradycardia)at 5 minutes before anesthesia,5 minutes after anesthesia and 10 minutes after anesthesia were compared between the two groups.Results There was no significant difference in the excellent and good rate of anesthesia between the two groups(P>0.05);The onset time of sensory and motor nerve block in ropivacaine group was longer than that in Bupivacaine group(P<0.01);There was no significant difference in sensory nerve recovery time between the two groups(P>0.05).Motor nerve recovery time in ropivacaine group was shorter than that in Bupivacaine group(P<0.01);The MAP and HR of the two groups decreased first and then increased,and there was no significant difference between the two groups at each time point(P>0.05).The HR of ropivacaine group was higher than that of Bupivacaine group at 5 min and 10 min after anesthesia(P<0.01);The total incidence of adverse reactions in ropivacaine group was 4.0%,lower than 12.0%in Bupivacaine group(χ^(2)=4.348,P=0.037).Conclusion Both ropivacaine and bupivacaine can obtain satisfactory anesthetic effect in combined spinal epidural anesthesia for cesarean section.However,ropivacaine has less interference on maternal hemodynamics,higher safety and faster recovery of postoperative motor nerve function,which is worthy of clinical application.

关 键 词：剖宫产 罗哌卡因 布比卡因 腰硬联合麻醉 血流动力学 不良反应 

分 类 号：R614[医药卫生—麻醉学]