0．75％罗哌卡因用于小儿蛛网膜下腔阻滞中的临床研究

目的探讨0．75％罗哌卡因用于小儿蛛网膜下腔阻滞的合适剂量。方法选择ASAⅠ-Ⅱ级择期手术的小儿患者60例．随机分为三组，每组20例。A组0．75％罗哌卡因2ml（按每厘米椎管长0．15mg给药）、B组0．75％罗哌卡因2ml（按每厘米椎管长0．3mg给药）、C组0．5％布比卡因2ml（按每厘米椎管长0．15mg给药）。用药后观察最高感觉阻滞平面等蛛网膜下腔阻滞运动和感觉参数、监测不同时间段的MAP、HR值和不良反应和并发症。结果A组最高阻滞平面、T10感觉平面阻滞持续时间、平面固定时间、运动起效时间、运动恢复时间，与C组比较，差异有统计学意义（F分别=0．16、7．03、0．57、19．23、1．17，P均〈0．05），与B组比较，差异有统计学意义（F分别=0．21、6．78、0．78、17．98、1．23，P均〈0．05）；A组下肢运动阻滞程度弱于C组，差异有统计学意义（x^2分别=40．83、21．16、10．42，P均〈0．05），与B组比较，差异有统计学意义（x^2分别=36．01、21．16、9．60，P均〈0．05）：B组运动恢复快于C组，差异有统计学意义（F=1．23，P〈0．05）；B组感觉阻滞起效时间与A组、C组比较，差异无统计学意义（F分别=4．13、4．54，P均〉0．05）。结论0．75％罗哌卡因每厘米椎长0．3mg用于小儿脊麻能达到安全麻醉：而0．75％罗哌卡因每厘米椎长0．15mg用于小儿脊麻，运动、感觉阻滞较布比卡因差。

Application of 0.75% ropivacaine for spinal anesthesia in children

Objective To observe the effects of different doses of ropivacaine for spinal anesthesia, and compare with bupivacaine. Methods Sixty ASAⅠ- Ⅱ children, scheduled for low abdominal surgery and lower limb operations were randomly allocated to three groups ,group A was received 0.75% ropivacaine 0.15mg/spinal length, group B was received 0.75% ropivacaine 0.3mg/spinal length, group C was received 0.5% bupivacaine 0.15mg/ spinal length. The onset time and duration,the upper level of anesthesia, degree of motor block were recorded , the vital signs of the kids were recorded during the surgery. Results There were statistic differences in the upper level of anesthesia , duration time of T10 sensory block, the fixed time of sensory block, onset time of motor block and the motor recuperation time between group A and group C （F = 0.16,7.03,0.57,19.23,1.17 , P〈 0.05）, and group B （F =0.21,6.78,0.78,17.98,1.23, P〈0.05）. The degree of the motor block of group A was weaker than group C（X^2= 40.83,21.16,10.42, P〈0.05）, and group B（X^2= 36.01,21.16,9.60,P〈0.05）. The motor recuperation time of group B was faster than group C （F=1.23,P〈0.05）. There were no differences in onset time of sensory block between group B and the other 2 groups （F= 4.13,4.54, P〉0.05,）.Conclusions 0.3mg/spinal length 0.75% ropivacaine is safe anesthesia for children; 0.15mg/spinal length ropivacaine is a weaker motor block and sensory block than bupivacaine.