罗哌卡因硬膜外给药时机对剖宫产术腰-硬联合麻醉效果的影响

目的 探讨在剖宫产术中不同硬膜外给药时机对罗哌卡因腰-硬联合麻醉效果的影响。方法40名产妇在行腰麻后（用0．4％罗哌卡因2ml）随机分为两组。组1：腰麻后15min经硬膜外导管给予0．5％罗哌卡因3ml试验量，5min后再注入7ml，然后开始手术。组2：腰麻后20min开始手术，在胎儿取出后经硬膜外导管予0．5％罗哌卡因3ml试验量5rain后再注入7ml。术中根据需要可以静脉追加芬太尼或氯胺酮，必要时可重复使用。记录不同时间痛觉阻滞平面、运动阻滞程度、腹肌松弛度、新生儿评分、产妇术中疼痛和静脉追加芬太尼与氯胺酮次数和剂量。结果腰麻后15min、手术开始时、手术开始后10min时两组平面差异无显著性。手术开始后20、30、40、50和60min时组1麻醉平面明显比组2高，差异有显著性（P〈0．05）。组1疼痛和肌松评估均明显优于组2（P〈0．05）。结论为获得较好麻醉效果，剖宫产术使用低浓度罗哌卡因腰麻时手术前为最佳硬膜外追加局麻药时机，胎儿取出后硬膜外追加用药效果往往较差。

Epidural Supplementation Opportunity of Ropivacaine on Effect of Combined Spinal and Epidural Anesthesia for Cesarean Section

Objective To compare the anesthetic effect of different opportunity of epidural ropivacaine supplementation on combined spinal and epidural anesthesia for Cesarean Section Methods After spinal anesthesia with 8mg isobaric ropivacaine in 2ml, forty patients undergoing Cesarean Section under combined epidural - spinal anesthesia were divided into two groups with twenty cases each. Twenty minutes later, the operation began after spinal anesthesia. A test dose of 15mg ropivacaine in 3ml was given by epidural catheter fifteen minutes later after spinal anesthesia and 0. 5% ropivacaine 35mg was injected after five minutes in groupl. After taking out of foetus, the same medication as groupl was administrated in group2. Adjuvant analgesics were intravenous infusion of fentanyl or ketamine by the judgement of the anesthetist. The onset and duration of sensory and motor block, motor block of the lower limb and abdominal muscle, the dose of adjuvant analgesics, adverse reactions, HR, BP,SpO2 during operation and Apgar score of neonates at 1 rain and 5min were recorded and compared. Results There was no significant difference in the two groups for the onset and duration of sensory and motor block at 15,20,30minutes after spinal anesthesia. There was significantly higher upper sensory level to pin prick in groupl comparing the CIA group at 20,30,40,50and 60minutes after surgery （P 〈 0. 05 ）. A significantly less VAS scores and better relaxation of abdominal muscle were found in groupl comparing group2 during surgery. Conclusion The better opportunity of epidural ropivacaine supplementation on combined spinal and epidural anesthesia for Cesarean Section was before the surgery, not after taking out of foetus. The latter had less satisfaction of patients and obstetrician.