罗哌卡因单次蛛网膜下腔阻滞对剖宫产术循环功能的影响韦福文广西桂林临桂西城医院麻醉科540011【摘要】目的探讨0.5%盐酸罗哌卡因或0.5%盐酸布比卡因单次蛛网膜下腔阻滞对剖宫产产妇循环功能的影响。方法选择80例急诊行剖宫产术的孕产妇，随机分为二组，于L2～3间隙行蛛网膜下腔穿刺，分别注入0.5%盐酸罗哌卡因3ml（A组）或0.5%盐酸布比卡因3ml（B组）。记录两组患者最高阻滞平面及到达时间,术中输液量和手术时间，记录麻醉前、麻醉后5分钟、麻醉后10分钟、麻醉后20分钟平均动脉压(MAP)和心率(HR)的变化。结果两组患者最高阻滞平面均在T7，最高阻滞平面达到时间、术中输液量、手术时间比较，差异无统计学意义。A组MAP在麻醉前后变化不明显；B组MAP在麻醉后5min、麻醉后10min、麻醉后20min下降明显，与麻醉前比较，差异有统计学意义（P＜0.05）。组间比较，差异有统计学意义（P＜0.05）。两组HR麻醉后变化不明显，组间比较差异无统计学意义。结论0.5%的盐酸罗哌卡因腰麻对血压的影响要显著小于同浓度的布比卡因，对患者循环功能影响小，安全性高于布比卡因，适用于急诊剖宫产术的麻醉。关键词罗哌卡因；蛛网膜下腔阻滞；剖宫产；循环功能1Ropivacaineorbupivacainesinglespinalanesthesiaincesareansectiononintraoperativecirculatoryfunction.WEIFu-wen,DepartmentofAnesthes-iology,XichengHospitalofLinGui,GuiLin,540011,China.[Abstract]ObjectiveTostudytheeffectsonmaternalhemodynamicsof0.5%ropivacaineor0.5%bupivacainsinglespinalanesthesiaincesareansection.MethodsEightypatientswithemergencycesareansectionmaternal,wererandomlydividedintotwogroups,thegapinthelineL2~3subarachnoidpuncture,wereinjected0.5%ropivacainehydrochloride3ml(Rgroup)or0.5%hydrochloricacidcloththancocaine3ml(Bgroup).Twogroupsofpatientsrecordedthehighestblockplaneandarrivaltime,intraoperativefluidvolumeandsurgicaltime,recordMAPandHRofbeforeanesthesia,anesthesiaafter5minutes、10minutes、20minutesafteranesthesia.ResultsTwogroupsofpatientswereinthehighestblockplaneT7,blockplanereachedthehighesttime,intraoperativetransfusion,operationtime,thedifferencewasnotstatisticallysignificant.MAPRgroupdidnotchangesignificantlybeforeandafteranesthesia;BgroupafteranesthesiaMAP5min,anesthesia10min,20minafteranesthesiadecreasedsignificantlycomparedwiththosebeforeanesthesia,thedifferencewasstatisticallysignificant(P<0.05).Betweenthetwogroups,thedifferencewasstatisticallysignificant(P<0.05).HRgroupsdidnotchangesignificantlyafteranesthesia,thedifferencebetweengroupswasnotstatisticallysignificant.Conclusion0.5%ropivacainehydrochloridespinal2anesthesiaonbloodpressurewassignificantlylessthanthesameconcentrationsofbupivacaine,littleeffectoncirculatoryfunctioninpatientswithhighsecurityinbupivacaineforemergencycesareansectionanesthesia.[Keywords]ropivacaine;subarachnoidblock;cesareansection;circulatoryfunction盐酸布比卡因是蛛网膜下腔阻滞常用的局麻药，但对产妇循环功能影响也较大。盐酸罗哌卡因是一种新型的纯左旋体长效酰胺类局麻药，目前已广泛运用在临床麻醉中。本研究通过在急诊剖宫产手术中，分别单独采用0.5%盐酸罗哌卡因或0.5%盐酸布比卡因行蛛网膜下腔阻滞,观察这两种麻醉方法对产妇循环功能的影响。1.资料与方法1.1一般资料经医院伦理委员会批准，患者均签署知情同意书。选择我院2012年6月至2013年2月急诊足月单胎产妇80例，ASAⅠ～Ⅱ级,随机分为两组，A组为0.5%盐酸罗哌卡因组，B组为0.5%盐酸布比卡因组，每组40例。所有患者术前心率和血压正常。两组产妇在年龄、体重、身高、孕周等方面比较，差异无统计学意义（P＞0.05），具有可比性。1.2用药方法两组蛛网膜下腔阻滞用药均配成等比重液，分别为0.5％盐酸罗哌卡因15mg/3ml（0.75％盐酸罗哌卡因2ml+0.9%氯化钠注射液1ml）；0.5％盐酸布比...
