等效剂量罗哌卡因和布比卡因腰麻-硬膜外联合麻醉用于剖宫产术的临床研究

目的探讨等效剂量罗哌卡因、布比卡因腰麻-硬膜外联合麻醉用于剖宫产术的临床效能及安全性。方法选择ASAⅠ～Ⅱ级足月妊娠初产妇80例,随机双盲法分为两组,每组各40例。罗哌卡因组（R组）：0.75%罗哌卡因2m1＋10%葡萄糖液0.5m1;布比卡因组（B组）：0.75%布比卡因1.25m1＋10%葡萄糖液1.25m1。术中麻醉效应不足时经硬膜外导管补充2%利多卡因。术中连续监测呼吸和循环状况,评估麻醉效能,观察围手术期不良反应的发生和新生儿情况。结果两组麻醉效能、最高阻滞平面、新生儿Apgar评分及不良反应相似（P〉0.05）,但R组起效慢,维持时间短（P〈0.05）;下肢运动阻滞程度R组显著低于B组（P〈0.05）。结论等效剂量的罗哌卡因和布比卡因腰麻-硬膜外联合麻醉用于剖宫产术安全有效,与布比广因相比,罗哌卡因对下肢运动阻滞弱且恢复迅速。

Clinical investigation of the isoeffect-dose of ropivacaine and bupivacaine for combined spinal-epidural anesthesia for caesarean section

【Objective】 To investigation the efficacy and safety of the isoeffect-dose of ropivacaine and bupivacaine for combined spinal-epidural anesthesia（CSEA） for caesarean section.【Methods】 Eighty primiparae（ASAⅠ-Ⅱ） schedualed for elective Misgave-Ladach-Method of caesarean section were divided into two groups with 40 cases each.Ropivacaine group（R） received 2mL of 0.75% ropivacaine with 0.5m1 of 10% glucose;bupivacaine group（B） received 1.25mL of 0.75% bupivacaine with 1.25mL of 10% glucose.It may be supplemented with 2% lidocaine via epidural catheter when the efficacy of spinal anaesthesia was poor.Blood pressure,heart rate and spo2 were assessed.Sensory and motor block,abdominal wall relaxation,apgar score of the neonates and side effects were recorded.【Results】 There was no significant difference among the two groups in the efficacy,the height of block,apgar score of the neonates and side effects（P0.05）,but the onset time was longer and duration of block shorter in ropivacaine group（p〈0.05）.Motor block was weaker with ropivacaine than that with bupivacaine（P0.05）.【Conclusion】 The isoeffect-dose of ropivacaine and bupivacaine were effective and safe for CSEA for both parturient and neonate.The recovery from motor block is faster with ropivacaine then that with bupivacaine.Appropriate dose of ropivacaine is safe and effective.