罗哌卡因在高位硬膜外麻醉中的效果观察

目的探讨罗哌卡因在高位硬膜外麻醉中对呼吸循环系统的影响以及临床效果。方法选择ASAⅠ-Ⅱ级乳腺手术患者40例，随机分为两组，每组20例，常规于T3-4间隙行硬膜外穿刺向头端置管。A组用0．25％罗哌卡因行硬膜外麻醉，B组用0．25％布比卡因行硬膜外麻醉。分别于麻醉前（T0）、麻醉后10min（T1）、30min（T2）、60min（T3）及术毕（T4），测定心率、血压、潮气量、呼吸频率、分钟通气量、阻滞时间和镇痛效果等指标。结果40例麻醉效果均佳，两组在T2、T3时心率、血压较麻醉前均有下降（P〈0．05），各项呼吸指标与术前比较差异无统计学意义。组间比较，在T2、T3时A组HR下降幅度小于B组，呼吸频率较B组变化更小（P〈0．05）。结论罗哌卡因能明显缩短阻滞起效时间，对感觉神经阻滞完善，镇痛效果好，对循环、呼吸功能影响小，用于高位硬膜外麻醉安全、有效。

Effects of ropivacaine in high epidural anesthesia

Objective To understand the effect of ropivacine in high epidural anesthesia on respiratory and circulatory system and its clinical effects. Methods Forty ASA Ⅰ-Ⅱ level patients underwent breast surgery were randomly divided into two groups, each group 20 cases. The patient were performed conventional puncture in the T3 -4 epidural space and placed the tube to head end. A group received 0. 25% ropivacaine epidural anesthesia, B group received 0. 25% bupivacaine epidural anesthesia. Respectively, before anesthesia （T0）, at 10 min （T1）, 30 min （T2 ）, 60 min （T3 ） after anesthesia and at end surgery （T4）, the heart rate, blood pressure, tidal volume, respiratory frequency, minute ventilation, block time and the analgesic effect and so on were measured. Results The narcotic effects of 40 patients were good. In the two groups the heart rate, blood pressure at T2 , T3 decreased than before anesthesia （P 〈 0.05）. The comparison of respiratory index before and after surgrey was no statistical significance. In inter-group comparison, decrese of HR at T2 , T3 in group A was less than that in B group, the changes of respira- tory rate in A group was smaller than that in B group （P 〈 0. 05）. Conclusion Ropivacaine block can significantly shorten the onset time of sensory nerve block, improve the analgesic effect, and have smaller effect on the circulatory and respiratory function, it is safe and effective for high epidural anesthesia.