低剂量等比重罗哌卡因腰硬联合麻醉在高原剖宫产中的应用

目的探讨低剂量等比重罗哌卡因腰硬联合麻醉(CSEA)在高原剖宫术中应用的麻醉效果。方法40例拟行剖宫产术的高原单胎孕妇,随机均分为2组。A组以0.75%罗哌卡因2 mL加入脑脊液1 mL稀释至3 mL后蛛网膜下腔注射,置入硬膜外导管,当麻醉平面过低或麻醉维持时间不够时,则经硬膜外导管注入2%利多卡因5 mL。B组以0.75%罗哌卡因1 mL加入脑脊液2 mL稀释至3 mL后蛛网膜下腔注射,置入硬膜外导管并经硬膜外导管注入2%利多卡因5 mL,随后的处理同A组。观察对比2组麻醉起效、恢复时间,麻醉效果优良率,不良事件发生率等。结果2组麻醉起效时间和麻醉优良率差异无显著意义(P>0.05)。与A组相比,B组的麻醉平面过高发生率低、术中追加利多卡因的例数多、麻醉恢复时间短,差异均有显著意义(P<0.05)。B组呼吸循环系统不良事件发生率为5%(1/20),低于A组(75%,15/20,P<0.05),新生儿5 min Apgar评分高于A组(P<0.05)。结论低剂量等比重罗哌卡因CSEA应用于高原剖宫产时,麻醉效果好,且安全,对新生儿无明显影响。

Application of low dose isobaric ropivacaine combined spinal-epidural anesthesia in cesarean section at high altitude

AIM To investigate the anesthesia effect of low dose isobaric ropivacaine combined spinal-epidural anesthesia in cesarean section at high altitude. METHEDS Forty single pregnant women undergoing cesarean section of plateau were randomly divided into group A and B, 20 cases in each group. In the group A, 0.75% of ropivacaine 2 mL mixed cerebrospinal fluid 1 mL were injected into subarachnoid space after lumbar puncture success by needle, then epidural catheter were put into epidural space, 2% lidocaine 5 mL were injected into epidural space by the epidural catheter when the anesthesia plane was too low or the anesthesia time was not enough. In the group B, 0.75% of ropivacaine 1 mL mixed cerebrospinal fluid 2 mL were injected into subarachnoid space after lumbar puncture success by needle, then epidural catheter were put into epidural space, 2% lidocaine 5 mL as experiment dose were injected into epidural space by the epidural catheter after the patients had been lay down, the subsequent processing was the same as group A. The time for anesthesia onset and the recovery, the excellent and good rate for anesthesia, the incidence of adverse events, and so on were observed and compared between the two groups. RESULTS The onset time and the rate of excellent and good of anesthesia had no significant different between two groups(P > 0.05). Compared with the group A, the incidence of high anesthesia plane was lower in the group B(P < 0.05), the number of cases of lidocaine supplementation was higher(P < 0.05), and the time for the anesthesia recovery was shorter(P < 0.05). The incidence of adverse events in the respiratory circulatory system was 5%(1/20) in the group B, and was lower than group A(75%, 15/20, P < 0.05). The 5 min neonatal Apgar score of the group B was higher than that of group A(P < 0.05). CONCLUSION Low dose isobaric ropivacaine combined spinal-epidural anesthesia at high altitude has good effective and is safe in cesarean section, no obvious effect on newborn.