摘要
目的 观察剖宫产术患者罗哌卡因复合芬太尼腰麻的临床效果及罗哌卡因的量效关系。方法 60例单胎、足月产妇,ASAⅠ-Ⅱ级,随机分为三组:1％罗哌卡因10mg+芬太尼20μg组(A组)、1％罗哌卡因13mg+芬太尼20μg(B组)、1％罗哌卡因15mg+芬太尼20μg(C组),每组20例。三组均L2-3穿刺行腰麻-硬膜外联合麻醉,蛛网膜下腔注药。记录三组的下肢运动阻滞情况、术中麻醉效果、硬膜外用药量、麻醉后不良反应、新生儿出生后1、5 min时Apgar评分及术后不良反应,用概率单位回归方法建立罗哌卡因的量效关系直线方程,计算ED50及ED95。结果 A组麻醉效果分级低于B组、C组(P<0.05)。三组的最高麻醉平面、达到最高平面的时间及达Bromage3级时间差异无显著性(P>0.05),而A组麻醉平面消退至T12的时间及Bromage分级恢复至0级时间均短于B组、C组(P<0.01)。A组有14例(70％)Bromage分级达到3级,低于B组、C组(P<0.05)。罗哌卡因的量效关系直线方程为:Y=-3.116+8.053logX,决定系数(r2)为0.9980 ED50(95％可信区间)和ED95(95％可信区间)分别为10.3(8.5-12.1)、[15.5(14.3-18.7)]mg。三组在麻醉后发生低血压、呼吸困难、恶心呕吐、寒战及钳产率等方面均无显著性差异。三组新生儿娩出后1、5 min的Apgar评分亦无显著性差异。
Objective To investigate the dose-response relationship of spinal ropivacaine when it is combined with spinal fentanyl 20 μg for cesarean section. Methods Sixty ASA Ⅰ-Ⅱ full-term nulliparous women undergoing cesarean section under combined spinal-epidural anesthesia (CSE) were randomized to receive spinal fentanyl 20μg and ropivacaine 10 mg (group A, n = 20) or 13 mg (group B, n = 20) or 15 mg (group C, n = 20) . Spinal puncture was performed at L2-3 interspace. A catheter was inserted 3 cm in the epidural space cephalad. If spinal analgesia was inadequate 2 % lidocaine was given epidurally. The clinical efficacy was rated based on analgesia, muscle relaxation and visceral traction response as Ⅰ-Ⅳ (Ⅰ= worst, Ⅳ= best). The probit log dose-response relationship was determined. The ED50 and ED95 of ropivacaine for spinal anesthesia when combined with spinal fentanyl 20 μg were calculated. Complications such as hypotension, nausea, vomiting and shivering were recorded. Results The three groups were comparable with respect to age, sex, body weight, height and duration of operation. The clinical efficacy in group B and C was significantly better than that in group A ( P <0.05). The probit log dose-response linear regression equation was Y (probit) = -3.116+8.053 logX; The coeffecient of determination (r2 ) 0.998. The ED50 of ropivacaine for spinal anesthesia combined with spinal fentanyl 20 μg was 10.3 mg and ED95 15.5 mg. There was no significant difference in complications among the 3 groups. Conclusion Intrathecal ropivacaine and fentanyl can be used safely and effectively for cesarean section. The ED50 of ropivacaine for spinal anesthesia when combined with spinal fentanyl 20 μg is 10.3 mg and ED95 15.5 mg.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2004年第11期823-825,共3页
Chinese Journal of Anesthesiology
