盐酸罗哌卡因腰麻用于剖宫产手术临床观察

目的:探讨盐酸罗哌卡因用于剖宫产手术腰麻的安全性与有效性。方法:60例ASAⅠ级～Ⅱ级拟行剖宫产手术患者,随机分为罗哌卡因组(R组)与布比卡因组(B组),每组30例。均于L2～3间隙穿刺,腰麻给药量分别为:R组罗哌卡因13mg(1%罗哌卡因1.3mL),B组布比卡因10mg(0.5%布比卡因2mL),均加10%葡萄糖稀释至2.0mL。观察剖宫产手术产妇的麻醉效果及麻醉期间对产妇的影响,。结果:R组血压降低及心率减慢发生率显著降低,与B组比较差异有统计学意义(P<0.05)。两组感觉运动阻滞起效时间R组长于B组,两组运动阻滞持续时间R组短于B组,差异有统计学意义(P<0.05)。结论:盐酸罗哌卡因腰麻与布比卡因相比,可减少麻醉并发症发生机会,提高剖宫产手术麻醉安全性。     

等效剂量罗哌卡因和布比卡因腰麻-硬膜外联合麻醉用于Misgave-Ladach-Method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Misgave -Ladach -Method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4 0例。罗哌卡因组(R组) :0 75 %罗哌卡因2ml 10 %葡萄糖液0 5ml;布比卡因组(B组) :0 75 %布比卡因1 2 5ml 10 %葡萄糖液1 2 5ml。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 0 5 ) ,但R组起效慢,维持时间短(P <0 0 5 ) ;下肢运动阻滞程度R组显著低于B组(P <0 0 5 )。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,与布比卡因相比,罗哌卡因对下肢运动阻滞弱且恢复迅速。     

布比卡因和罗哌卡因在瘢痕子宫剖宫产术中的应用对比

目的:观察布比卡因、罗哌卡因在瘢痕子宫剖宫产术中的应用。方法:将腰硬联合麻醉下择期行瘢痕子宫剖宫产术的健康产妇120例随机分为三组(n=40):0.5%罗哌卡因10mg组(R_1组)、0.5%罗哌卡因15mg(R_2组)和0.5%布比卡因10mg(B组)。采用针刺法测定感觉阻滞平面,改良Bromage评分法测定下肢运动神经阻滞程度,比较三组患者感觉和运动阻滞效果,肌肉松弛满意度和不良反应。结果:与B组比较,R_1和R_2组的感觉阻滞起效时间、运动阻滞起效时间延长(P0.05);R1和R2的感觉阻滞恢复时间、运动阻滞恢复时间明显缩短(P0.05);R_1和R_2组的低血压、心率缓慢、恶心呕吐、寒颤发生率较低(P0.05)。R_1组肌肉松弛效果不满意。结论:0.5%罗哌卡因15mg与0.5%布比卡因10mg腰硬联合麻醉用于瘢痕子宫剖宫产术麻醉效果满意,罗哌卡因运动阻滞维持时间短,对循环影响小,更适合瘢痕子宫剖宫产。     

重比重与等比重罗哌卡因腰麻应用于剖宫产手术的比较

目的探讨重比重与等比重局部麻醉药在剖宫产手术蛛网膜下腔麻醉(腰麻)中应用的优缺点.方法选择ASAⅠ～Ⅱ级的拟行短时间(≤1小时)剖宫产手术病例160例,随机分为重比重组(80例)和等比重组(80例),用联合腰麻硬膜外麻醉(CSEA)技术经L2、L3间隙实施腰麻,均采用0.67%罗哌卡因2.5 ml,比较两组患者围手术期血流动力学变化及注药后患者的反应、麻醉起效及消退时间、感觉阻滞的峰平面等.结果与重比重组相比,等比重组感觉阻滞、运动阻滞起效时间较重比重组长,改良Bromage运动评分更高(P＜0.05),感觉阻滞平面下降2节段的时间较重比重组短,运动阻滞恢复较重比重组快,低血压、恶心、呕吐发生率较重比重组低(P＜0.05).结论等比重局麻药运动阻滞恢复较快,低血压、恶心、呕吐发生率较少,较重比重局麻药在剖宫产手术腰麻中具有明显的优越性.     

不同剂量盐酸罗哌卡因腰硬联合麻醉在剖宫产手术中的应用研究

目的 探讨不同剂量盐酸罗哌卡因腰硬联合麻醉在剖宫产手术中的应用效果。方法 选取100名经剖宫产手术分娩的产妇,根据随机数字表法分为两组,各50名。所有产妇剖宫产手术中均实施腰硬联合麻醉,对照组予以2 ml 0.5%盐酸罗哌卡因,试验组予以1.5 ml 0.5%盐酸罗哌卡因。比较两组麻醉质量及血流动力学指标。结果 两组运动阻滞起效时间、感觉阻滞起效时间以及麻醉平面固定时间对比,差异无统计学意义（P>0.05）。麻醉后10 min至手术结束时,两组平均动脉压、心率水平有不同幅度波动,试验组平均动脉压、心率水平幅度显著小于对照组（P<0.05）。结论 对于剖宫产手术产妇在腰硬联合麻醉时应选用小剂量盐酸罗哌卡因,血流动力学的波动相对较小,维持麻醉质量更理想。     

0.5%和0.375%罗哌卡因腰硬联合麻醉用于剖宫产术中麻醉的效果观察

目的 观察分析剖宫产术中麻醉采用0.5%和0.375%罗哌卡因腰硬联合麻醉的效果。方法 选取我院100例剖宫产产妇作为研究对象。随机分为观察组(采用0.5%盐酸罗哌卡因进行腰麻)和对照组(采用0.375%盐酸罗哌卡因进行腰麻),将两组产妇各时点的舒张压(DBP)、收缩压(SBP)、心率(HR)以及产妇满意度等情况进行对比分析。结果 两组产妇HR、SBP以及DBP等各项指标在麻醉前的差异无统计学意义(P0.05),但观察组产妇在切皮时的HR、SBP、DBP等各项指标水平显著低于对照组,差异有统计学意义(P0.05),而且观察组产妇分娩后5 min的HR水平明显低于对照组,差异有统计学意义(P0.05)。观察组患者满意度为92%明显高于对照组的70%,差异有统计学意义(P0.05)。结论 剖宫产术中麻醉采用罗哌卡因腰硬联合麻醉选择0.375%、0.5%浓度的麻醉效果都是安全、有效的,具有良好的镇痛效果,0.5%浓度罗哌卡因对于患者的机体循环有较大影响,具有良好的肌松效果,而且患者的满意度较高,因此在腰硬联合麻醉中的麻醉浓度应该适当。     

蛛网膜下腔注入罗哌卡因在1万例剖宫产中的应用

目的:探讨罗哌卡因在蛛网膜下腔应用的麻醉效果及安全性。方法:应用0.894%甲磺酸罗哌卡因1.4～1.8ml加25%GS0.4～0.6ml,注入蛛网膜下腔,然后置导管入硬膜外腔,执行腰硬联合麻醉行剖宫产术;并与盐酸罗哌卡因进行比较。结果:1万例剖宫产手术麻醉,均安全满意,效果确实,无一例出现神经毒性反应。结论:罗哌卡因蛛网膜下腔麻醉,效果确实,安全。     

甲磺酸罗哌卡因腰麻剖宫产术对母婴的影响

罗哌卡因是一种新型酰胺类局麻药,具有对中枢神经系统和心血管系统毒性低,感觉阻滞与运动阻滞分离等特点[1],目前临床已广泛应用.盐酸罗哌卡因腰麻用于剖宫产术已有报道,但国产甲磺酸罗哌卡因腰麻行剖宫产术的报道尚少.     

罗哌卡因腰麻复合硬膜外阻滞麻醉用于分娩镇痛对初产妇产程的影响

腰麻复合硬膜外阻滞麻醉用于分娩镇痛因其起效快 ,镇痛效果明显及安全性好而越来越多用于临床。特别是新的酰胺类局部麻醉药物罗哌卡因具有使感觉神经和运动神经分别阻滞的特性 ,使产妇处于可行走状态下的分娩镇痛成为可能。本研究通过对罗哌卡因腰麻复合硬膜外阻滞麻醉分娩镇痛的观察 ,探讨其对产妇产程进展的影响 ,现将结果报道如下。一、资料和方法1.对象选择及方法 :选择我院 2 0 0 0年 1月至 2 0 0 0年 6月拟行自然分娩的单胎、足月初产妇 6 6例。随机分为罗哌卡因腰麻复合硬膜外阻滞麻醉组 (研究组 )和肌内注射度冷丁镇痛组 (对照组 )…     

小剂量罗哌卡因复合芬太尼用于腰硬联合阻滞分娩镇痛的临床观察

目的：观察小剂量罗哌卡因复合芬太尼用于腰硬联合阻滞分娩镇痛的效果及不良反应。方法：选择足月单胎头位临产初产妇120例,ASAI或Ⅱ级,均无椎管内麻醉禁忌和产科高危因素,随机分为腰硬联合阻滞组（观察组）和无镇痛组（对照组）各60例,观察两组第一、二产程的视觉模拟疼痛评分（VAS评分）、运动神经阻滞程度评估（改良Bromage法）、产程时间、催产素使用、器械助产、剖宫产及产妇不良反应情况,并进行新生儿APgar评分。结果：观察组第一、二产程VAS明显低于对照组（P〈0.05）,两组产妇运动神经阻滞评估及产程时间差异无统计学意义,器械助产率和催产素使用观察组高于对照组（p〈0.05）,剖宫产率观察组明显低于对照组（P〈0.05）,观察组有2例出现下肢皮肤轻度瘙痒,新生儿APgar评分两组差异无统计学意义。结论：小剂量罗哌卡因复合芬太尼用于腰硬联合阻滞分娩镇痛效果确切,对产程进展及新生儿无不良影响,是一种理想的分娩镇痛方法。     

Lidocaine 4% cream compared with lidocaine 2.5% and prilocaine 2.5% or dorsal penile block for circumcision

This study evaluated the efficacy and safety of lidocaine 4% cream (LMX4), compared with lidocaine 2.5% and prilocaine 2.5% (EMLA) or dorsal penile block (DPNB) for analgesia during circumcision. Healthy, term males (n = 54), younger than 1 week old undergoing circumcision were randomly assigned to open-label pretreatment with LMX4, EMLA, or DPNB. Heart rate (HR; beats per minute [bpm]), respiratory rate (RR; breaths/minute), and arterial oxygen saturation as measured by pulse oximetry (Sp O2; %) were monitored at baseline, and during drug application, circumcision, and recovery. Mean differences were compared using the general linear model. At the end of drug application, mean HR for infants receiving LMX4 (146 bpm; standard error of mean [SEM], 8.0 bpm) was lower than that for DPNB (176 bpm; SEM, 8.3 bpm; p < 0.05). No significant difference in mean HR was observed between treatments during circumcision. Mean RR was higher during circumcision for EMLA compared with LMX4 (p < 0.05) and DPNB (p < 0.05). At lysis, mean RR was significantly lower in DPNB than LMX4 and EMLA. The number of Sp O2 samples was too small for comparison. Three infants (one receiving LMX4 and two receiving EMLA) experienced local reactions (p = 0.54). No adverse effects were observed with DPNB. No difference in analgesic efficacy was observed between treatments according to HR. Differences in RR may reflect a varying level of analgesia. The safety profile was similar for all treatments. LMX4 is an effective analgesic for newborn circumcision.     

Use of a whole blood substitute, Fluosol-DA 20%, after massive postpartum hemorrhage

Two patients with severe postpartum hemorrhage refused blood product transfusion for religious reasons. The patients' hemoglobin level had dropped to 3.0% or less after operative intervention, and the cardiac indexes on transfer to the tertiary care center were 8.0 and 7.3 L/minute per m2, respectively. Each received an infusion of Fluosol-DA 20% according to research protocol after obtaining informed written consent. Pulse rates and cardiac outputs dropped after the infusions. They were discharged from the hospital 17 and 15 days later with hemoglobins of 7.0 and 5.1%, respectively. Fluosol-DA 20% may be a useful adjunct for therapy of postpartum hemorrhage in women who refuse blood products for religious reasons.     

Electrolyte studies in blood,urine and liquor after intra-amniotic instillation of 20% sodium chloride

Electrolyte changes were studied in 150 women undergoing second trimester abortion with 20% sodium chloride instilled intraamniotically. There was no significant rise in serum sodium; peak levels were reached within 4 hours and then declined. Reported deaths from hypernatremia seem to follow instillations which are too fast and are under pressure. Urinary sodium peaked at 6 hours, then declined. Sodium levels in liquor reach nearly 5 times preinjection levels by 2 hours, then decline. Chloride levels more or less parallel sodium levels. Generally sodium levels in blood rise from 142 to 145.6, in urine from 356 to 464, and in liquor from 190 to 1150. Chloride levels in blood rise from a mean of 94 to 106, in urine from 210 to 295, and in liquor from 145 to 1130. It is concluded that hypertonic saline is a cheap and effective abortion procedure if done correctly.     

Inflammation increases vulnerability to hypoxia in newborn piglets: effect of reoxygenation with 21% and 100% O2

OBJECTIVE: The purpose of this study was to assess whether inflammation increases vulnerability to hypoxia, and influences the effect of 100% O(2) and 21% O 2 reoxygenation on brain. STUDY DESIGN: Newborn piglets (n = 31) were randomized to 4 interventional groups: pretreatment with saline or endotoxin. After hypoxia they were reoxygenated with 21% or 100% oxygen for 30 minutes, followed by 21% oxygen for all groups. To assess brain injury we measured extracellular brain tissue glucose, glycerol, and lactate/pyruvate by microdialysis, brain tissue oxygen tension, and laser Doppler flow. RESULTS: Administration of endotoxin reduced the time to reach base excess (BE) -20 mmol/L by median 32 minutes compared with saline ( P < .05). We found no differences in changes in biochemical markers, brain tissue microcirculation, or oxygen tension between piglets in the 4 groups. CONCLUSION: Endotoxin and hypoxia acted synergistically in inducing metabolic acidosis. In the presence of experimental inflammation, 21% oxygen seems as effective as 100% O(2) in reoxygenating piglets.