不同麻醉药物用于剖宫产腰麻-硬膜外联合麻醉临床观察

目的：探讨罗哌卡因与布比卡因、地卡因的腰麻-硬膜外联合麻醉用于剖宫产术的安全性和有效性。方法：将90例产妇随机分为A、B、C组。用0．89％甲磺酸罗哌卡因（A组）、0．75％布比卡因（B组）和1％地卡因（C组）各1ml，分别加入10％葡萄糖1ml和3％麻黄素1ml配成重比重溶液，蛛网膜下腔注药2～3ml，术中酌情于硬膜外给予0．89％罗哌卡因或2％利多卡因5～10ml维持麻醉。观察比较3组患者在感觉、运动阻滞及恢复时间上的异同，并观察用药后的不良反应及对新生儿的影响。结果：A组患者感觉和运动的最大阻滞起效时间均较B、C组长（P〈0．05）；3组在最大感觉阻滞平面上差异无统计学意义（P〉0．05）；A组患者术后感觉恢复时间比B、C组短（P〈0．05）；A组患者最大Bromage评分多为0～1级，明显小于B、C组（P〈0．05）；最大运动阻滞时间比B、C组长（P〈0．05），而运动阻滞完全恢复时间短于B、C组（P〈0．05）；A组患者低血压、恶心、呕吐的发生率低于B、C组（P〈0．05）；新生儿Apgar评分及术后头痛的发生率无明显差异（P〉0．05）。结论：腰麻-硬膜外联合麻醉可显著提高麻醉的成功率，效果较好，对产妇和胎儿均是安全有效的。

A clinical study on different anesthesia medication in combined and epidural anesthesia in caesarean section

Objective: To investigate the safety and effect of ropivacaine,bupivacaine and teracaine in caesarean section in combined spinal and epidural anesthesia.Methods: Ninety parturients were randomly divided into three groups.Made high density mixture from 0.89% ropivacaine(group A),0.75% bupivacaine(group B) and 1% teracaine(group C) 1 ml,respectively puls,10% glucose 1 ml and 3% ephedrine 1 ml respectively.In all parturients,a Tuohy needle(B.D) was introduced into the L2-3 epidural space,and 2~3 ml medicine was injected into subarachnoid space in 0.1 ml/s.Parturients received extradural injection 0.89% ropivacaine or 2% lidocaine 5~10 ml to maintain block level.To compare difference in sensory block,motor block and recovery time in three groups.Side-effects and effect on neonate score were observed.Results: The onset time of maximum sensory block and motor block in group A was prolonged compared with group B and group C(P<0.05);There were no significantly difference in maximum sensory block level in three groups(P>0.05);Effect time in group A was shorter than group B and group C(P<0.05); Onset time of motor block in group A was prolonged compared with group B and group C(P<0.05),maximum Bromage score was 0~1 in group A,significantly smaller(P<0.05),time of maximum motor block was prolonged(P<0.05),time of motor motor block disappear was shorter(P<0.05);The incidence of hypotension,nausea vomiting in group A was lower(P<0.05);Neonatal Apgar score and incidence of postoperation headache had no significantly difference(P>0.05).Conclusion: Ropivacaine is safety and high effective in caesarean section in combined spinal and epidural anesthesia for parturient and neonatal.