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目的比较小剂量罗哌卡因复合芬太尼蛛网膜下阻滞用于新式剖宫产术的临床可行性。方法选择急诊剖宫产术者50例,随机分成两组,每组均为25例。A组:罗哌卡因7.5mg+芬太尼20μg;B组:罗哌卡因15mg.两组均加入10%葡萄糖配成重比重液2.5ml.用体表针刺法测感觉平面,用改良Bromage法测运动阻滞,观察两种不同配方的麻醉效果、血流动力学清况、感觉阻滞起效时间、运动阻滞起效时间、最高感觉阻滞平面、平面固定时间以及运动恢复时间,记录新生儿娩出后1、5分钟时Apgar评分。结果A组感觉阻滞起效时间较B组慢(P<0.01),平面固定时间较B组快(P<0.05),镇痛维持时间差异无显著性(P>0.05)。麻醉最高平面A组和B组分别为T6和T4～T2,两者比较差异有显著性(P<0.01)。下肢运动阻滞起时间A组较B组慢(P<0.01),但运动恢复时间A组较B组快(P<0.01)。B组血流动力学的影响较A组明显,在注药后的5min,血压、心率显著降低,与基础值比较,差异显著性(P<0.05)。A组低血压、心动过缓和恶心、呕吐发生率显著少于B组(P<0.01)新生儿娩出后1、5分钟Apgar评分A、B两组无显著性差异。结论小剂量罗哌卡因复合芬太尼蛛网膜下腔阻滞用于新式剖宫产能减少局麻药用量,麻醉效果确切,对机体血流动力学影响小,能能延长镇痛时间,运动恢复时间短,并且可减少术后恶心呕吐的发生率。
Objective To compare the clinical feasibility of a new dose of ropivacaine combined with fentanyl subarachnoid block for cesarean section. Methods Fifty cases of emergency cesarean section were randomly divided into two groups, each group was 25 cases. Group A: ropivacaine 7.5mg + fentanyl 20μg; Group B: ropivacaine 15mg. Both groups were added 10% glucose with heavy specific gravity 2.5ml. Body surface acupuncture measured sensory plane, with improved Bromage method was used to measure motor block. The anesthetic effect, hemodynamic status, onset time of sensory block, onset time of motion block, maximum plane of sensory block, plane fixation time and recovery time of two different formulations were observed. , Apgar scores were recorded at 1, 5 minutes after the newborn was delivered. Results The onset time of sensory block in group A was slower than that in group B (P <0.01), and the plane fixation time was faster than that in group B (P <0.05). There was no significant difference in the duration of analgesic maintenance between group A and group B (P> 0.05). The highest level of anesthesia in group A and group B were T6 and T4 ~ T2, the difference was significant (P <0.01). The time of lower extremity block was shorter in group A than in group B (P <0.01), but the recovery time was faster in group A than in group B (P <0.01). The effect of hemodynamics in group B was more obvious than that in group A, and the blood pressure and heart rate were significantly decreased 5 minutes after injection, which was significantly different from the baseline values (P <0.05). The incidence of hypotension, bradycardia and nausea and vomiting in group A were significantly lower than those in group B (P <0.01). There was no significant difference in Apgar scores A and B between 1 and 5 minutes after delivery. Conclusion Low-dose ropivacaine combined with fentanyl subarachnoid block for the new cesarean section can reduce the amount of local anesthetic, anesthesia exact effect on the body hemodynamics small, can prolong the analgesic time, exercise Recovery time is short, and can reduce the incidence of postoperative nausea and vomiting.