文章摘要
生理盐水硬膜外容量扩张对剖宫产蛛网膜下腔阻滞时0.75%罗哌卡因半数有效剂量的影响
Effect of the intrathecal 0.75% ropivacaine for cesarean section with epidural volume expansion by normal saline on the median effective dose
  
DOI：10.12089/jca.2021.06.007
中文关键词: 罗哌卡因  剖宫产  蛛网膜下腔阻滞  硬膜外容量扩张
英文关键词: Ropivacaine  Cesarean section  Subarachnoid block  Epidural volume expansion
基金项目:四川省卫生和计划生育委员会资助项目（17PJ239）
作者单位E-mail
张健 610045,四川省妇幼保健院,成都医学院附属妇女儿童医院麻醉科 anesthesiology@zju.edu.cn 
曹远锋 湖南省妇幼保健院麻醉科  
张丹 610045,四川省妇幼保健院,成都医学院附属妇女儿童医院妇女保健科  
卢冬梅 610045,四川省妇幼保健院,成都医学院附属妇女儿童医院麻醉科  
朱思颖 610045,四川省妇幼保健院,成都医学院附属妇女儿童医院麻醉科  
曾薇 610045,四川省妇幼保健院,成都医学院附属妇女儿童医院麻醉科  
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中文摘要:
      
目的 探讨硬膜外注生理盐水10 ml进行硬膜外容量扩张（EVE）对剖宫产产妇0.75%罗哌卡因蛛网膜下腔阻滞（简称腰麻）半数有效剂量（ED50）的影响。
方法 足月单胎初产妇60例，体重50～80 kg，ASA Ⅱ级，孕期＞37周。采用随机数字表法将产妇分为两组：EVE组（E组）和对照组（C组），每组30例。两组均在超声引导下行L3-4间隙腰麻，蛛网膜下腔给予0.75%罗哌卡因后，E组硬膜外推注生理盐水10 ml，C组不给予任何液体。序贯法0.75%罗哌卡因初始剂量为10 mg，根据上一例产妇的镇痛效果，上调或下调下一例产妇所需罗哌卡因剂量，上调或下调的浓度梯度为1 mg。观察腰麻效果，采用Probit回归分析计算罗哌卡因的ED50及ED95。
结果 C组0.75%罗哌卡因腰麻的ED50为12.050 mg（95%CI 11.215～12.953 mg），ED95为13.683 mg（95%CI 12.816～15.692 mg）；E组0.75%罗哌卡因腰麻的ED50为9.915 mg（95%CI 9.321～10.471 mg），ED95为11.548 mg（95%CI 10.878～13.255 mg）。
结论 剖宫产产妇0.75%罗哌卡因腰麻的ED50为12.050 mg（95%CI 11.215～12.953 mg），硬膜外生理盐水10 ml容量扩张能使其用量减少约17.7%。
英文摘要:
      
Objective To investigate the median effective dose (ED50) of intrathecal 0.75% ropivacaine followed by epidural volume extension with 10 ml saline for cesarean section.
Methods Sixty full-term singleton primiparas, weighing 50-80 kg, ASA physical status Ⅱ, at gestational period > 37 weeks, were divided into two groups according to the random number table method: epidural volume expansion group (group E) and control group (group C), 30 patients in each group. Both groups underwent ultrasound-guided spinal anesthesia in the L3-4 intervertebral space. Epidural normal saline 10 ml was given after the intrathecal dose of 0.75% ropivacaine in group E, and no epidural injection of normal saline was given after the intrathecal dose of 0.75% ropivacaine in group C. The dose of ropivacaine for each parturient was administered according to up-down sequential method. The initial dose was 10 mg. According to the analgesic effect of the previous parturient, the dosage of ropivacaine required for the next parturient was increased or decreased 1 mg. Probit regression analysis were applied to calculate the ED50 and ED95 of ropivacaine in the two groups. The effect of spinal anesthesia and adverse reactions of parturient were observed.
Results The ED50 of 0.75% ropivacaine for spinal anesthesia was 12.050 mg (95% CI 11.215-12.953 mg) in group C, and the ED95 was 13.683 mg (95% CI 12.816-15.692 mg). The ED50 of ropivacaine was 9.915 mg (95% CI 9.321-10.471 mg) in group E, and the ED95 was 11.548 mg (95% CI 10.878-13.255 mg).
Conclusion Under the conditions of this experiment, the ED50 of intrathecal 0.75% ropivacaine for cesarean section is 12.050 mg (95% CI 11.215-12.953 mg), which is reduced by approximately 17.7% followed by epidural volume expansion with 10 ml saline.
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