硬膜外持续泵注罗哌卡因阻滞的临床研究

目的:探讨硬膜外持续泵注新型长效酰胺类局麻药罗哌卡因的可行性.方法:将60例拟行妇产科手术的患者随机分为0.75%罗哌卡因组持续泵入给药组(A组)和0.75%罗哌卡因组间断给药组(B组).两组均在L2～3硬膜外穿刺成功并给予实验量后,A组(30例)硬膜外注入0.75%罗哌卡因12mL,然后以6mL/h的速度用微泵持续输入;B组(30例)注入0.75%罗哌卡因15mL,在80min后时追加6mL.分别测定麻醉前及硬膜外给药后的平均动脉压(MAP)、心率(HR);首次注药后至手术结束时针刺皮肤测阻滞平面,同时记录改良Bromage评分,术中肌松质量由手术者评定(手术者为同一组人),分为很满意、满意和不满意;记录术中麻黄素使用情况.结果:B组在90min左右时血压出现明显下降,与A组比较差异有统计学意义(P＜0.05),A组术中麻黄素使用病例数较少(P＜0.05).两组间皮肤阻滞平面、Bromage评分和术中肌松情况比较差异无统计学意义(P＞0.05).结论:硬膜外微泵持续泵入罗哌卡因的给药方法既可以达到间断给药法同样的麻醉效果,又避免了间断法造成血压大幅波动的缺点,是一种较为安全的给药方法.

Epidural anesthesia with ropivacaine by computerized infusion pump

ObjectiveTo explore the feasibility of epidural anesthesia with ropivacaine by computerized infusion pump. MethodsSixty patients scheduled for obstetric operation were divided into a continuous pump infusion group (Group A, n=30) and a conventional injection group (Group B, n=30). The initial doses of 0.75% ropivacaine 12mL and 15mL were respectively injected into the patient's epidural space in Group A and Group B. The dose of 6mL of 0.75% ropivacaine per hour was continuously pumped to maintain the anesthesia till the end of the operation in Group A, and 6 mL of 0.75% ropivacaine was injected 80min later in Group B. ResultsBlood pressure in some patients markedly decreased at 90min after the first injection in Group B while it is relatively stable in Group A (P<0.05). The number of patients who had to inject ephedrine to raise the blood pressure in Group A was smaller than that in Group B during the operation (P<0.05). There was no significant difference in the anesthetic level between Group A and Group B (P>0.05). ConclusionEpidural anesthesia with ropivacaine by computerized infusion pump is safe, which can not only provide an excellent anesthetic effect but also keep the hemodynamics stable.