摘要
目的 :探讨罗比卡因椎管内联合麻醉对剖宫产妇皮质醇及胎儿的影响。方法 :选择ASAⅠ～Ⅱ级足月妊娠产妇 40例 ,随机双盲等分两组。腰麻用药分别为罗比卡因 (R组 )或布比卡因 (B组 ) 1 0～ 1 5ml。术中麻醉效果下降时可从硬膜外置管中补充 1 6 %利多卡因。围术期连续监测呼吸和循环状态 ,定时测产妇血糖、血清皮质醇浓度 ,评估出生时新生儿Apgar评分并行脐动脉血气分析 ,记录术中产妇安全相关指标。结果 :两组产妇术中清醒合作 ,麻醉效果均可以满足手术要求。两组产妇新生儿出生时Apgar评分均为 10分 ,脐动脉血气结果正常。术中R组产妇胎儿娩出和术毕时MAP下降明显 (P <0 0 5 ) ,且组间差异明显 (P <0 0 5 ) ,同时胎儿娩出时HR增快 (P <0 0 5 ) ,术毕HR减慢 (P <0 0 5 ) ;B组产妇仅胎儿娩出时MAP下降 (P <0 0 5 )。两组产妇于胎儿娩出和术毕时血糖浓度明显升高 (P <0 0 5 ) ,皮质醇浓度仅B组产妇术中明显升高 (P <0 0 5 )。R组HR减慢次数明显增多 (P <0 0 5 )。结论 :0 75 %罗比卡因适用于椎管内联合麻醉剖宫产 ,麻醉效能与同等浓度布比卡因相近 ,对新生儿无不良影响 ;但罗比卡因对交感神经的阻滞性强于布比卡因 ,术中易有BP波动 ,抑制皮质醇分泌明显。
Objective:To explore the effect of ropivacaine combined spinal epidural anaesthesia on the parturients serum cortisol and neonates.Methods:40 ASA physical status 1 or 2 parturients undergoing caesarean section were randomly divided into two groups of 1 1 5ml intrathecal 0 75% ropivicaine(R) and 1 1 5ml intrathecal 0 75% bupivacaine(B).It may be supplemented with 1 6% lidocaine via epidural catheter when the efficacy of spinal anaesthesia was poor.Study parameters included sensory blockade(pin prick),drug dosage,respiratory and circulatory response,intraoperative serum cortisol and blood glucose,Apgar scores for neonates and umbilical artery blood gas determinations.Results:Anesthetic effects were excellent in both groups.There were no significant differences in neonatal Apgar scores and umbilical artery blood gas( P> 0 05).Comparaed with preoperation,MAP decreased more significantly during suture in group R than that in group B( P< 0 05),HR increased significantly after delivery and decreased significantly during suture in group R( P< 0 05),MAP decreased significantly after delivery in B group( P< 0 05).The blood glucose concentration was significantly increased after delivery and during suture in both groups( P< 0 05).The serum cortisol concentration was significantly increased after delivery and during suture in B group( P< 0 05).Bradycardia occured more significantly in group R than that in group B( P< 0 05).Conclusion:The efficacy of 0 75% ropivacaine combined spinal epidural anaesthesia for caesarean section is similar to that of 0 75% bupivacaine and no side effect on neonate in the study doses,but 0 75% ropivacaine is more potent in blocking sympathetic nerve,in comparison with 0 75% bupivacaine,resulting in marked cardiovascular changes and the serum cortisol inhibition.
出处
《临床麻醉学杂志》
CAS
CSCD
2000年第10期497-499,共3页
Journal of Clinical Anesthesiology
关键词
罗比卡因
椎管内联合麻醉
剖宫产
皮质醇
Ropivacaine Combined spinal epidural anaesthesia Caearean section
