剖宫产术麻醉中不同药物适合目标导向式控制阻滞平面应用效果  

Application efficacy of target-oriented control block plane of anesthesia during cesarean section

作　　者：梅培毅 吴继敏[1] 武旖旎 叶绿菊 MEI Peiyi;WU Jimin;WU Yili;YE Lvju(Lishui People's Hospital,Lishui,Zhejiang Province,323000;Lishui Maternal and Child Health Cere Hospital)

机构地区：[1]浙江省丽水市人民医院,323000 [2]浙江省丽水市妇幼保健院

出　　处：《中国计划生育学杂志》2022年第12期2778-2782,共5页Chinese Journal of Family Planning

摘　　要：目的:探讨适合目标导向式控制阻滞平面在剖宫产麻醉中的应用效果。方法:选择2021年1月-2021年12月在本院行剖宫产手术的孕产妇98例,随机分为观察组和对照组各49例。观察组采用0.67%罗哌卡因,穿刺间隙为L3~4;对照组采用0.5%布比卡因,穿刺间隙为L2~3。观察两组在切皮时刻及胎儿娩出时刻的阻滞平面,运动及感觉阻滞时间时间、血流动力学和应激指标及低血压发生情况。结果:两组术前血流动力学指标无差异(P>0.05),给药后5min、10min平均动脉压和心率观察组均优于对照组(P<0.05);观察组麻醉前、麻醉后即刻和术后1h的皮质醇(Cor)、内皮素(ET)、超氧化物歧化酶(SOD)、丙二醛(MDA)均无差异(P>0.05),对照组麻醉后即刻Cor、ET、SOD高于麻醉前和术后1h,MDA低于麻醉前和术后1h(P<0.05);在切皮时刻和胎儿娩出时刻的阻滞平面,对照组较观察组有更多产妇的阻滞平面超过T8和T6,且需要追加麻醉药物补救(P<0.05);两组感觉阻滞起效时间无差异(P>0.05),观察组运动阻滞维持时间和感觉阻滞维持时间短于对照组,运动阻滞起效时间长于对照组(P<0.05);观察组术中低血压发生率(10.2%)低于对照组(24.5%)(P<0.05)。结论:剖宫产麻醉中采用0.67%罗哌卡因,适合目标导向式控制阻滞平面,可降低产妇低血压发生,血流动力学更稳定。Objective: To explore the application efficacy of target-oriented control block plane of anesthesia during cesarean section. Methods: From January 2021 to December 2021, 98 pregnant women who wanted cesarean section were selected and were randomly divided into observation group and control group(49 cases in each group). The women in the observation group received 0.67% ropivacaine, and the puncture interval was L3-4, while the women in the control group received 0.5% bupivacaine, and the puncture interval was L2-3. The block plane, the block time of motor and sensory, the indexes of hemodynamics and stress, and the occurrence of hypotension at the time of skin incision and the fetal delivery of the women in the two groups were observed. Results: There were no significant difference in the preoperative hemodynamic indexes levels of the women between the two groups(P>0.05). The mean arterial pressure and heart rate of the women in the observation group at 5min and 10min after administration were significantly better than those of the women in the control group(P<0.05). There were no significant differences in the levels of cortisol(Cor), endothelin(ET), superoxide dismutase(SOD), and malondialdehyde(MDA) levels of the women in the observation group among before anesthesia, immediately after anesthesia, and 1h after anesthesia(P>0.05). The levels of Cor, ET, and SOD of the women in the control group immediately after anesthesia were significantly higher than those before anesthesia and 1h after anesthesia, but the MDA level immediately after anesthesia was significantly lower than that before and 1h after anesthesia(P<0.05). Compared with those of the women in the observation group at the time of skin dissection and fetal delivery, more women in the control group had more than T8 and T6 block planes, and additional anesthetic drugs were needed(P<0.05). There was no significant difference in the onset time of sensory block of the women between the two groups(P>0.05). The maintenance time of motor block or sensory blo

关 键 词：剖宫产术麻醉 适合目标导向式控制阻滞平面 罗哌卡因 布比卡因 血流动力学 低血压 

分 类 号：R614[医药卫生—麻醉学]