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目的:观察盐酸罗哌卡因与盐酸布比卡因用于腰麻-硬膜外联合阻滞在剖宫产术中的麻醉效果、不良反应及对新生儿预后的影响。方法:ASA分级Ⅰ~Ⅱ、拟行剖宫产手术的低危产妇120例,随机分为两组接受腰麻-硬膜外联合阻滞:罗哌卡因组(R组),给予患者罗哌卡因11 mg单次腰麻;布比卡因组(B组),给予患者布比卡因11 mg单次腰麻;对于两组中手术时间长于1 h的患者,从硬膜外导管追加2%利多卡因5 ml。监测血流动力学变化,比较两组手术时间、感觉阻滞起效时间、到达最高阻滞平面时间、最高阻滞平面消退/感觉恢复时间、运动阻滞起效时间、运动完全恢复时间、镇痛效果、最大Bromage评分、肌松效果、评估麻醉效应和胸闷、恶心呕吐等不良反应发生情况;评估新生儿Apgar评分,测定分娩即刻脐动脉血pH值。结果:罗哌卡因组的感觉阻滞起效时间、到达最高阻滞平面时间显著短于布比卡因组(P<0.05);罗哌卡因组的运动阻滞起效时间、达最高改良Bromage分值时间明显慢于布比卡因组(P<0.05),而运动完全恢复时间显著快于布比卡因组(P<0.05)。两组镇痛效果、肌松效果、新生儿Apgar评分、手术时间、感觉恢复时间比较,差异均无统计学意义(P>0.05);两组血压与心率的比较,R组效果更佳(P<0.05);两组术后恶心呕吐、呼吸抑制等不良反应比较,差异均无统计学意义(P>0.05)。结论:两种麻醉方法均可以满足临床需要,但罗哌卡因组麻醉总体效果优于布比卡因组,运动神经阻滞恢复更快,便于产妇早期下床活动。
Objective: To observe the effects of anesthesia, adverse reactions and prognosis of ropivacaine hydrochloride and bupivacaine hydrochloride for spinal anesthesia and epidural blockade in cesarean section. Methods: 120 cases of low-risk maternal women undergoing cesarean section under ASA classification Ⅰ ~ Ⅱ were randomly divided into two groups: group receiving Ropivacaine combined with spinal anesthesia-epidural block (R group) Bupivacaine (group B) given a single dose of 11 mg bupivacaine for each patient; patients in the two groups who had surgery longer than 1 h were treated with epidural catheter Add 2% lidocaine 5 ml. The hemodynamic changes were monitored. The operative time, the onset time of sensory block, the time to reach the maximum block level, the maximum block level, the onset time of block, the complete recovery time, Pain effect, maximum Bromage score, muscle relaxant effect, assessment of anesthetic effects and chest tightness, nausea and vomiting and other adverse reactions; assessment of neonatal Apgar score, determination of umbilical artery immediately after delivery of blood pH. Results: The onset time of sensory block in ropivacaine group was significantly shorter than that in bupivacaine group (P <0.05), and the onset time of motion block in ropivacaine group was the highest The modified Bromage score was significantly slower than that of bupivacaine group (P <0.05), while the complete recovery time of exercise was significantly faster than that of bupivacaine group (P <0.05). There was no significant difference in analgesic effect, muscle relaxant effect, Apgar score, operation time and sensory recovery time between the two groups (P> 0.05). The blood pressure and heart rate in both groups were better than those in group R (P <0.05). There was no significant difference between the two groups in postoperative nausea and vomiting, respiratory depression and other adverse reactions (P> 0.05). Conclusion: Both anesthesia methods can meet the clinical needs. However, the general anesthesia in ropivacaine group is better than bupivacaine group, and the recovery of motor nerve block is faster and the maternal ambulation is easier to get out of bed.