重比重罗哌卡因腰麻

重比重罗哌卡因腰麻 重比重罗哌卡因腰麻 【摘要】 研究重比重罗哌卡因腰-硬联合阻滞在急诊宫产术中的麻醉有效性和安全性。方法 选择ASA I-II级、单胎、足月产妇急诊行剖宫产患者60例，随机分成3组，每组20例。分别用0.75%罗哌卡因10mg(A组)、12mg(B组)、15mg(C组)加入3%麻黄素15mg，10%葡萄糖1ml配成重比重液。于L2,3间隙穿刺，蛛网膜下腔注入麻醉药，观察麻醉起效时间、麻醉持续时间、麻醉效果;新生儿 Apgar 评分及麻醉并发症。结果 三组患者麻醉起效时间、麻醉最高阻滞平面差异无显着性(P0.05)。A组麻醉持续时间明显短于B组、C组，且三组麻醉效果有差异 (P0.05)。硬膜外追加2%利多卡因者A组(65%)高于B组(20%) 和C组(15%) 差异有显着性(P0.05)。三组麻醉后5min血压低于麻醉前(P0.05)，C组明显低于A组(P0.05)。其他各时间点血变化差异无显着性 (P0.05)。三组间各时间点心率、血氧饱和度及新生儿Apgar 评分差异无显着性。C组的恶心呕吐、胸闷气短发 生率高于A组和 B组,差异有显着性 (P0.05)。结论 0.75%罗哌卡因12?在急诊剖宫产术腰麻-硬膜外联合阻滞时的有效剂量 。 【关键词】 罗哌卡因 布比卡因 腰麻-硬膜外联和麻醉 剖宫产 【Abstract】 Objective To study the clinical effect and safety of high-concentration ropivacaine for bined spinal-epidural anesthesia used in emergency caesarean section. Methods Sixty ASA class I-II patients with single birth and planed to do emergency caesarean sections were randomly and equally divided into 3 groups. Group A, B and C were received 10mg, 12mg and 15mg of 0.75% ropivacaine bined with 3% ephedrine 15mg and 10% glucose 1ml respectively. The anaesthetic was injected into epidural administration after applied L2-3 interspace. The onset time, duration, anesthesia effect, newborn Apgar and its plications were detected.Results There was no significant difference in statistics among three groups in anesthesia onset time and block level (P0.05). The anesthesia duration of group A is less than Group B and C obviously, and there were difference in anesthesia effect among three groups (P0.05). After adding 2% Lidocaine on epidural, the effective rates of group A, B and C were 65%, 20% and 15% respectively, with significant differences among three groups (P0.05). Five minutes after anesthesia, the blood pressure of three groups decreased significantly and group C was lower than that of group A (P0.05). Systolic pressure had no statistic meaning. No statistic difference on heart rate, Blood Oxygen Saturation and newborn Apgar between each group. Nausea and vomiting, or with chest distress and suffocated happened on group C, from statistic point of view, it was higher than those of group A and B (P0.05). Conclusion 12mg of 0.75% ropivacaine is the effective dose for bined spinal-epidural anesthesia on emergency caesarean section 【Key words】 ropivacaine;bupivacaine; bined spinal-epidural anesthesia;caesarean section 大多数剖宫产手术为急诊手术，对于麻醉的要求是既要起快、镇痛完全、肌肉松弛，又要保持产妇血流动力学稳定，药物对胎儿影响小。腰麻,硬膜外联合阻滞麻醉 (CSEA)近年来已广泛在临床应用，它具有起效快、作用完全、麻醉药用量少、麻醉持续时间不受限等优点。但它也有一过性血压下降和呼吸抑制等缺点。本文通过观察罗哌卡因用于急诊剖宫产术的临床效果，探究安全有效的用药方法。 1 与方法 1.1 病例选择和分组 选择ASA I-II级,初产足月、单胎产妇60例，年龄22,35岁,体重55,75kg,身高155,170cm,无先兆子痫、妊高征等产科并发症，无椎管麻醉穿刺禁忌证者。随机分成三组: 每组20例，分别用0.75%罗哌卡因AstraZeneca 生产10mg(A组)、12mg(B组)、15mg(C组)加入3%麻黄素15mg，10%葡萄糖1ml配成重比重液麻药。 1.2 麻醉方法及处理 患者入室后常规监测心电图、血压、心率和血氧饱和度。常规面罩吸氧，建立静脉通路，并在0.5h内静脉输注复方林格氏液300,500ml。采用国产腰麻,硬膜外麻醉联合阻滞包，患者取右侧卧位，头侧抬高30度，以L2,3为穿刺点。局麻药加入麻黄素15mg，硬膜外穿刺成功后，置入腰穿针有脑脊液流出，以0.1ml/s速度注入药物2.5,3.2ml。注药后退出腰麻针，向头侧置入硬膜外管2,2.5cm。退出硬膜外穿刺针，患者平卧位，调整手术床左倾15,30?，从注药完毕到翻身平卧在1min内完成。待麻醉作用减弱时，经硬膜外追加2%利多卡因5,8ml 维持麻醉。若手术中收缩压低于基础血压30%或90mmHg时，静注麻黄碱20,30mg;如心率低于55次,min，静注阿托品0.3,0.5mg。术中维持输液1500ml，其中血定安500ml;复方林格氏液1000ml。 1.3 监测指标 术中连续监测血压、心率、脉搏、血氧饱和度和心电图;痛觉组织 测定: 采用体表针刺法，测定感觉消失节段为阻滞平面。于给药后,min内每分钟测定,次，以后3,5min测定,次，至手术开始。观察感觉起效阻滞时间、最高阻滞平面和感觉及运动阻滞时间;应用改良Bromage法评定下肢运动阻滞情况: 0分—无阻滞;1分—不能抬腿;2分—不能屈膝;3分—不能伸踝;从镇痛、肌松效果、牵拉反应三方面评价麻醉效果: 优—患者无不适，镇痛效果好，腹肌松弛，无牵拉反射;良—患者有轻微不适，腹肌稍紧，轻度牵拉反应，但可配合手术;差—患者感疼痛，腹肌紧张，牵拉反应严重，需辅助镇静、镇痛药才能完成手术。记录新生儿娩出后 1、5min时Apgar评分;及术中不良反应。 1.4 统计学处理 所有资料数据用均数?差(x?s)表示，计量资料组间比较采用单因素方差分析，计数资料采用率及卡方检验。 P0.05为差异有显着性。