不同比重盐酸罗哌卡因在下腹部和下肢手术病人连续腰麻的比较

目的：比较不同比重等容等量盐酸罗哌卡因在下腹部和下肢手术中连续腰麻的影响。方法：下肢或下腹部手术病人60例，ASAⅠ～Ⅲ，随机分成C1组（轻比重液）、C2组（等比重液）、C3组（重比重液），每组20例，穿刺点选择L3-4蛛网膜下腔头向置入，Spinocath24G@管，分别注入上述局麻药1ml，根据麻醉平面（维持在T10平面左右）追加0．5ml至麻醉满意为止，观察给药前T0（基础值）、首剂麻醉后0．5min（T1），1min（T2），3min（T3），15min（T4），30min（T5）循环呼吸功能的变化，比较3组感觉阻滞平面，改Bromage评分，维持时间，最高阻滞平面，运动阻滞恢复时间，辅助用药，平均局麻药总量及不良反应。结果：3组麻醉后MAP（T1～T4）较基础值（T0）有显著降低（P〈0．01）。C1组使用阿托品、麻黄素例数较C2、C3组明显增多，C3组运动恢复时间明显增加，3组镇静剂使用麻醉药总量无显著差异。结论：不同比重的罗哌卡因腰麻后对循环功能产生一定的影响，均可满足下腹部或下肢手术的麻醉要求．但使用等比重液更适合此类手术。

Clinical eomparision of different specific gravities of ropivaeaine in continuous spinal anesthesia of lower abdominal and limb surgery

Objective ：To compare the effect of different specific gravities of ropivacaine in contlnous spinal anesthesia （CSA） of lower abdominal and limb surgery.Methods：Sixty patients,aged 25 to 75 years,scheduled for lower abdominal and limb surgery,were randomly allocated to three groups with 20 cases each ,C1 （hypobarie）,C2（isobarie）,C3（hyperbaric）.A 24-gauge Spinocath catheter was advanced 1.5-2.0 cm into subarachnoid space at L3-4 interspace.The patients in C1 ,C2,C3 groups were given correspond ropivacalne solution.K analgesia did not reach T10 after 10-15 rain,the half dose was repeated.Blood pressure,heart rate, motor, sensory blockade were evaluated and adverse effects were recorded.Results：There was significant difference in MAP,HR after anesthesia in15 min as compared to the base values at TO.More patients in C1 group received ephedrine and atropine compared with C2 and C3 groups.The maximum Bremage＇s score and motor regressive time were significant longer than those in C1 ,C3 groups.Conclusion：Coutinous spinal anesthesia with different specific gravities of ropivacaine is safe and effective in lower abdominal and limb surgery.Isobaric solution has the advantage of better anesthesia with hemodynamie stability and lower adverse effects as compared to hypobarie and hyperbaric local anesthetics.