等比重罗哌卡因蛛网膜下腔麻醉在剖宫产手术中的应用研究

目的探讨等比重罗哌卡因蛛网膜下腔麻醉在剖宫产手术中的应用。方法选择我院2009年1月～2010年1月间64例剖宫产产妇作为研究对象。64例产妇根据使用罗哌卡因比重情况随机分为I组（等比重罗哌卡因）、Ⅱ组（重比重罗哌卡因），各32例；比较两组MAP、HR、SPO2麻醉前后的变化；下肢运动阻滞评分采用改良Bromage评分方法评定感觉阻滞胸椎平面、最大运动阻滞时间、运动恢复时间、两组不良反应（低血压、恶心、呕吐、寒战、新生儿Apgar评分低于8分）发生率。结果Ⅱ组心率（HR）麻醉后5min明显降低，术后10min恢复至麻醉前水平；Ⅱ组SPO2（％）麻醉后5min明显降低，术后10min较麻醉前无显著变化（P〉0．05）。应用改良Bromage评分方法观察，l组最大运动阻滞时间、运动恢复时间均明显短于Ⅱ组，差异有统计学意义（P〈0．05或P〈0．01）。但两组感觉阻滞胸椎平面比较，差异无统计学意义（P〉0．05）。I组麻醉后低血压、恶心、呕吐不良反应的发生率均明显低于Ⅱ组（P〈0．05）。且新生儿Apgar评分低于8分的例数为0，明显低于Ⅱ组新生儿Apgar评分低于8分的发生率（P〈0．05）。结论等比重罗哌卡因应用于剖宫产能取得较好的麻醉效果，对血压、心率影响小，麻醉术后低血压、恶心呕吐等并发症发生率较低，起效迅速、阻滞效果显著、阻滞后消退时间更短。

The Application of Isobaric Ropivacaine Spinal Anesthesia in Cesarean Section

Objective To investigate the application of isobaric ropivacaine spinal anesthesia in cesarean section surgery. Methods 64 cases underwent caesarean section were select in our hospital from January 2009 to January 2010 in study.64 cases of maternal use of ropivacaine in accordance with the proportion of cases were randomly divided into group Ⅰ （isobaric ropivacaine）,group Ⅱ （hyperbaric ropivacaine）,32 cases in every group.Of 32 patients,these were compared：MAP,HR,SPO2 before and after anesthesia changes and lower limb motor block score assessed by modified Bromage scoring thoracic sensory block plane,the maximum motor blockade, exercise recovery time, adverse events （hypotension, nausea, vomiting, chills, Apgar scores below 8 points） rate. Results heart rate（HR） in the group Ⅱ decreased after anesthesia 5min,after anesthesia 10 min returned to the level before anesthesia. SPO2（%） in the group Ⅱ decreased after anesthesia 5rain,after anesthesia 10 rain no significant changes compared with before anesthesia （P〉0.05）. Modified Bromage score were observed,the maximum motor blockade,exercise recovery time in the group Ⅰ was shorter than those in the group Ⅱ ,the difference was statistically significant（P〈0.05 or P〈0.01）. But Thoracic sensory block plane there was no significant （P〉0.05）.Group Ⅰ after anesthesia hypotension,nausea,vomiting,ehills,adverse events were significantly lower than those in the group Ⅱ （P〈0.05）. And neonatal Apgar score less than 8 points to 0 the number of patients was significantly lower than that in the group Ⅱ （P〈0.05）. Conclusion The isobaric ropivacaine used in cesarean section could achieve better effects of anesthesia,blood pressure, heart rate is small,the incidence of hypotension after anesthesia,the incidence of complications such as nausea and vomiting, rapid onset of block was significant,subsided after block shorter.