不同剂量罗哌卡因行腰麻-硬膜外联合阻滞在阴式子宫切除术中的应用

目的：研究不同剂量的重比重罗哌卡因腰-硬联合阻滞在阴式子宫切除术中的麻醉有效性和安全性。方法：选择ASAⅠ～Ⅱ级,患者120例,随机分成3组,每组40例。分别用0.75%罗哌卡因10 mg（A组）、15 mg（B组）、18 mg（C组）分别加入3%麻黄碱15 mg及10%葡萄糖1 mL配成重比重液。于L2-3间隙穿刺,蛛网膜下腔以0.1 mL.s-1速度注入麻醉药,在硬膜外腔留置导管。观察生理指标变化、麻醉起效时间、麻醉持续时间和麻醉效果及不良反应。结果：3组患者麻醉起效时间、麻醉绝对最高阻滞平面差异无统计学意义（P〉0.05）。A组麻醉持续时间明显短于B、C组,且3组麻醉效果差异有统计学意义（P〈0.05）。3组血压手术开始时均低于麻醉前,且C组明显低于A组差异有统计学意义（P〈0.05）。3组间各时间点心率、血氧饱和度差异无统计学意义。C组的恶心呕吐、胸闷、气短发生率高于A组和B组,差异有统计学意义（P〈0.05）。结论：在阴式子宫切除术应用0.75%罗哌卡因15 mg腰麻-硬膜外联合阻滞是有效安全的剂量。

Application of Different Dosage of Ropivacaine for Combined Spinal - Epidural Anesthesia in Transvaginal Hysterectomy

OBJECTIVE： To evaluate the efficacy and safety of different dosage of hyperbaric ropivacaine for combined spinal-epidural anesthesia in transvaginal hysterectomy. METHODS： 120 patients （ASA class Ⅰ- Ⅱ） were randomly assigned to to receive hyperbaric solution prepared from 0.75 % ropivacaine （10 mg for Group A, 15 mg for Group B and 18 mg for Group C） plus 3% ephedrine 15 mg and 10% glucose 1 mL. Puncturation was performed at L2-3 interspace, and the anaesthetic was injected into subarachnoid cavity at a speed of 0.1 mL·s^-1 and catheter was placed at epidural cavity. The physiological indexes, the time to response and duration of anesthesia, the anesthetic effect and the side effects were followed. RESULTS： There were no significant differences across the three groups in the time to response and the absolute highest block level （ P 〉 0.05）. The anesthesia duration in group A was significantly shorter than in group B and C, and there were significant differences in anesthetic effect among the three groups （ P 〈 0.05）. The blood pressure values of the three groups at the beginning of surgery were all lower as compared with before anesthesia （ P 〈 0.05）, significantly lower in group C than in group A （ P 〈 0.05 ）. There were no significant differences across the three groups in heart rate, blood oxygen saturation and ECG at different time point. The incidences of nausea and vomiting, chest distress and short breath in group C were significantly higher than in group A and group B （P 〈 0.05）. CONCLUSION： 15 mg of 0.75 % ropivacaine was proved to be effective and safe for combined spinal - epidural anesthesia in transvaginal hysterectomy.