不同浓度罗哌卡因用于妇科手术的麻醉效果比较
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摘要
目的:分析妇科手术麻醉中同等剂量不同浓度罗哌卡因的麻醉效果及安全性。方法:选取本院2017年2月-2018年2月择期实施妇科手术,依据美国麻醉学会(SAS)评定为Ⅰ～Ⅱ级的患者63例,随机分为3组,各21例,即罗哌卡因0.50%(低浓度组)、0.75%(中浓度组)、1.00%(高浓度组),硬膜外麻醉。比较各组麻醉阻滞效果,T4、T8、T12脊神经节段感觉镇痛起效时间,感觉阻滞平面,运动阻滞起效及持续时间,监测平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)变化。结果:各组硬膜外麻醉T4、T8、T12脊神经节段感觉镇痛起效时间、感觉阻滞平面、镇痛持续时间、运动阻滞持续时间均无差异(P>0.05);低浓度组术毕即刻Bromage评分均高于中浓度组和高浓度组,运动阻滞达到2级与3级阻滞标准时间长于低浓度组和高浓度组(P<0.05);中浓度组与高浓度组硬膜外麻醉效果无差异(P>0.05);各组术后自控镇痛(PCEA)镇痛药物使用剂量比较,低浓度组咪唑安定、氯胺酮、0.2%罗哌卡因、吗啡剂量使用最多,高浓度组最低,各组妇科手术期T1、T2、T3、T4时间点MAP、HR、SpO2比较无差异(P>0.05)。结论:0.5%、0.75%、1.0%浓度罗哌卡因均可应用于妇科手术,麻醉平面起效及持续效果良好,0.5%罗哌卡因对腹壁肌肉松弛度及术后镇痛效果较差,1.0%罗哌卡因在麻醉阻滞、肌松及镇痛效果完善,但需考虑神经损伤风险;0.75%罗哌卡因麻醉效果最佳,即可满足妇科手术需求,亦减少了高浓度罗哌卡因潜在并发症风险。
Objective:To analyze the anesthetic effect and safety of ropivacaine in the same dose and different concentration in gynecological surgery.Methods:From February 2017 to February 2018,63 patients undergoing gynecologic surgery were randomly divided into 3groups:ropivacaine 0.50% group(n=21),ropivacaine 0.75% group(n=21),ropivacaine 1.00% group(n=21)according to the evaluationⅠ?Ⅱlevel by the American Society of Anesthesia(SAS).The onset time of sensory analgesia,the level of sensory block,the onset and duration of motor block,the changes of mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation(SpO2)of patients were compared among the three groups.Results:There were no significant different in the onset time of sensory analgesia,the level of sensory block,the duration of analgesia and the duration of motor block among the three groups(P>0.05).Bromage score of patients in 0.50% group was significant higher than that of patients in 0.75% group and 1.00% group(P<0.05).The standard time of motor block of patients in 0.5% group was significant longer than that of patients in0.75% group and 1.00% group(P<0.05).There was no significant difference in the effect of epidural anesthesia between 0.75%group and 1.00%group(P>0.05)The dosage of PCEA analgesic drugs used in 0.50%group had significant different(P<0.05),the dosage of ketamine,0.2%ropivacaine,and morphine used in 1.00%group was the lowest.There was no significant difference in the changes of MAP,HR,and SpO2 among the three groups at the time point of T1,T2,T3 and T4(P>0.05).Conclusion:0.50%,0.75% or 1.00%ropivacaine all can be used in gynecological operation,which has good level of sensory block and lasting effect.The relaxation of abdominal wall muscle and the analgesic effect of postoperative analgesia when 0.5% ropivacaine used are less than those of 1.00% ropivacaine used.The effect of muscle relaxation and analgesia is perfect when 1.00%ropivacaine used,but it is necessary to consider the risk of nerve injury.So 0.75%ropivacaine used is the best,which can meet the needs of gynecological surgery,and can reduce the potential complication risk of high concentration ropivacaine.
Objective:To analyze the anesthetic effect and safety of ropivacaine in the same dose and different concentration in gynecological surgery.Methods:From February 2017 to February 2018,63 patients undergoing gynecologic surgery were randomly divided into 3groups:ropivacaine 0.50% group(n=21),ropivacaine 0.75% group(n=21),ropivacaine 1.00% group(n=21)according to the evaluationⅠ?Ⅱlevel by the American Society of Anesthesia(SAS).The onset time of sensory analgesia,the level of sensory block,the onset and duration of motor block,the changes of mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation(SpO2)of patients were compared among the three groups.Results:There were no significant different in the onset time of sensory analgesia,the level of sensory block,the duration of analgesia and the duration of motor block among the three groups(P>0.05).Bromage score of patients in 0.50% group was significant higher than that of patients in 0.75% group and 1.00% group(P<0.05).The standard time of motor block of patients in 0.5% group was significant longer than that of patients in0.75% group and 1.00% group(P<0.05).There was no significant difference in the effect of epidural anesthesia between 0.75%group and 1.00%group(P>0.05)The dosage of PCEA analgesic drugs used in 0.50%group had significant different(P<0.05),the dosage of ketamine,0.2%ropivacaine,and morphine used in 1.00%group was the lowest.There was no significant difference in the changes of MAP,HR,and SpO2 among the three groups at the time point of T1,T2,T3 and T4(P>0.05).Conclusion:0.50%,0.75% or 1.00%ropivacaine all can be used in gynecological operation,which has good level of sensory block and lasting effect.The relaxation of abdominal wall muscle and the analgesic effect of postoperative analgesia when 0.5% ropivacaine used are less than those of 1.00% ropivacaine used.The effect of muscle relaxation and analgesia is perfect when 1.00%ropivacaine used,but it is necessary to consider the risk of nerve injury.So 0.75%ropivacaine used is the best,which can meet the needs of gynecological surgery,and can reduce the potential complication risk of high concentration ropivacaine.
引文
[1]胡佳,李有长,徐茜.全身麻醉联合硬膜外麻醉与单纯全身麻醉对妇科腹腔镜手术的麻醉效果比较[J].中国医药导报,2016,13(2):129-132.
[2]刘成,彭英.硬膜外麻醉与全麻在妇科腹腔镜手术中的应用[J].四川医学,2011,32(11):1762-1764.
[3]程英莉,吴建平,卢银军,等.罗哌卡因与布比卡因对剖宫产手术腰-硬联合麻醉患者血流动力学的影响[J].中国临床药理学杂志,2016,32(6):526-528.
[4]Hubler M,Planitz M C,Vicent O.Early pharmacokinetic of ropivacaine without epinephrine after injection into the psoas compartment[J].Br J Anaesth,2016,116(1):141-142.
[5]张喜林.麻醉科临床禁忌手册[M].北京:中国协和医科大学出版社,2008:437-448.
[6]李云翔.罗哌卡因复合舒芬太尼硬膜外麻醉在腹腔镜卵巢囊肿切除术中的应用[J].中国计划生育学杂志,2016,24(9):614-616.
[7]张延卓,董宏,席宏杰.罗哌卡因局部麻醉对妇科腹腔镜手术术后镇痛的研究[J].哈尔滨医科大学学报,2010,44(4):365-368.
[8]陈秋芬,高秀娟,蔡兴志,等.罗哌卡因联合布托啡诺对妇科腹腔镜手术后疼痛影响的对照研究[J].中国微创外科杂志,2015,15(1):33-35.
[9]涂兵权.阴式子宫切除术中应用右旋美托咪啶联合低浓度罗哌卡因腹横肌膜神经阻滞的有效性及安全性[J].中国计划生育学杂志,2017,25(3):181-183.
[10]Soni P.Comparative study for better adjuvant with ropivacaine in epidural anesthesia[J].Anesth Essays Res,2016,10(2):218-222.
[11]孙志华,郭曲练,邹望远.间断鞘内注射不同浓度罗哌卡因对大鼠脊髓及神经根早期超微结构的影响[J].中华麻醉学杂志,2005,25(4):283-287.
[12]马马丽,李彩娟,冯善武.0.15%罗哌卡因硬膜外给药用于分娩镇痛中爆发痛的治疗效果[J].临床麻醉学杂志,2017,33(2):148-151.
[13]韩斌,徐铭军,张明.罗哌卡因、舒芬太尼单独或混合用药连续蛛网膜下腔阻滞用于分娩镇痛效果的比较[J].中华麻醉学杂志,2016,36(11):1309-1312.
[14]白洁,孟玮,黄生辉.腹腔镜胆囊切除术后不同浓度罗哌卡因腹横肌平面阻滞镇痛效果的随机对照研究[J].第三军医大学学报,2017,39(7):696-700.
[15]陈新艳,王蕾,牛世坤,等.不同麻醉方法对妇科手术患者免疫功能的影响[J].中国医药导报,2017,14(16):59-62.
[16]房建,赵继蓉.小剂量罗哌卡因联合舒芬太尼腰硬联合麻醉在无痛分娩中的应用[J].中华全科医学,2018(2):264-267.
[17]黄焕娟,詹鸿,张秀燕,等.硬膜外低浓度罗哌卡因行分娩镇痛的临床观察[J].实用医学杂志,2001,17(5):445-446.
[18]Singh M,Pathak A,Khan A,et al.Comparative Study of Clonidine with Ropivacaine versus Ropivacaine Alone in Epidural Anesthesia for Lower Limb Orthopedic Surgery[J].Anesth Essays Res,2017,11(4):1035-1039.
[19]张研,胡允梅,屠伟峰.罗哌卡因蛛网膜下腔阻滞的研究进展[J].国际麻醉学与复苏杂志,2007,28(1):54-55.
[20]孟宪斌,崔丽强,王岩,等.罗哌卡因在妇产科手术中镇痛效果观察[J].山东医药,2011,51(17):97-97.
[2]刘成,彭英.硬膜外麻醉与全麻在妇科腹腔镜手术中的应用[J].四川医学,2011,32(11):1762-1764.
[3]程英莉,吴建平,卢银军,等.罗哌卡因与布比卡因对剖宫产手术腰-硬联合麻醉患者血流动力学的影响[J].中国临床药理学杂志,2016,32(6):526-528.
[4]Hubler M,Planitz M C,Vicent O.Early pharmacokinetic of ropivacaine without epinephrine after injection into the psoas compartment[J].Br J Anaesth,2016,116(1):141-142.
[5]张喜林.麻醉科临床禁忌手册[M].北京:中国协和医科大学出版社,2008:437-448.
[6]李云翔.罗哌卡因复合舒芬太尼硬膜外麻醉在腹腔镜卵巢囊肿切除术中的应用[J].中国计划生育学杂志,2016,24(9):614-616.
[7]张延卓,董宏,席宏杰.罗哌卡因局部麻醉对妇科腹腔镜手术术后镇痛的研究[J].哈尔滨医科大学学报,2010,44(4):365-368.
[8]陈秋芬,高秀娟,蔡兴志,等.罗哌卡因联合布托啡诺对妇科腹腔镜手术后疼痛影响的对照研究[J].中国微创外科杂志,2015,15(1):33-35.
[9]涂兵权.阴式子宫切除术中应用右旋美托咪啶联合低浓度罗哌卡因腹横肌膜神经阻滞的有效性及安全性[J].中国计划生育学杂志,2017,25(3):181-183.
[10]Soni P.Comparative study for better adjuvant with ropivacaine in epidural anesthesia[J].Anesth Essays Res,2016,10(2):218-222.
[11]孙志华,郭曲练,邹望远.间断鞘内注射不同浓度罗哌卡因对大鼠脊髓及神经根早期超微结构的影响[J].中华麻醉学杂志,2005,25(4):283-287.
[12]马马丽,李彩娟,冯善武.0.15%罗哌卡因硬膜外给药用于分娩镇痛中爆发痛的治疗效果[J].临床麻醉学杂志,2017,33(2):148-151.
[13]韩斌,徐铭军,张明.罗哌卡因、舒芬太尼单独或混合用药连续蛛网膜下腔阻滞用于分娩镇痛效果的比较[J].中华麻醉学杂志,2016,36(11):1309-1312.
[14]白洁,孟玮,黄生辉.腹腔镜胆囊切除术后不同浓度罗哌卡因腹横肌平面阻滞镇痛效果的随机对照研究[J].第三军医大学学报,2017,39(7):696-700.
[15]陈新艳,王蕾,牛世坤,等.不同麻醉方法对妇科手术患者免疫功能的影响[J].中国医药导报,2017,14(16):59-62.
[16]房建,赵继蓉.小剂量罗哌卡因联合舒芬太尼腰硬联合麻醉在无痛分娩中的应用[J].中华全科医学,2018(2):264-267.
[17]黄焕娟,詹鸿,张秀燕,等.硬膜外低浓度罗哌卡因行分娩镇痛的临床观察[J].实用医学杂志,2001,17(5):445-446.
[18]Singh M,Pathak A,Khan A,et al.Comparative Study of Clonidine with Ropivacaine versus Ropivacaine Alone in Epidural Anesthesia for Lower Limb Orthopedic Surgery[J].Anesth Essays Res,2017,11(4):1035-1039.
[19]张研,胡允梅,屠伟峰.罗哌卡因蛛网膜下腔阻滞的研究进展[J].国际麻醉学与复苏杂志,2007,28(1):54-55.
[20]孟宪斌,崔丽强,王岩,等.罗哌卡因在妇产科手术中镇痛效果观察[J].山东医药,2011,51(17):97-97.