靶控输注瑞芬太尼辅助硬膜外麻醉行剖宫产的可行性

THE FEASIBILITY OF EPIDURAL ANESTHESIA WITH TCI OF REMIFENTANIL IN CESAREAN SECTION

目的探讨靶控输注瑞芬太尼辅助硬膜外麻醉下行剖宫产术的可行性。方法择期硬膜外麻醉下行剖宫产术足月孕产妇100例,ASA Ⅰ～Ⅱ级。按照瑞芬太尼血浆靶控浓度不同随机分为5组(n=20),R1～R4组(分别为1.0、1.5、2.0与2.5μg/L),C组(单纯硬膜外)为对照组。阻滞平面达T_6～T_8为满意,按预定不同血浆药物浓度开启静脉注射泵输注瑞芬太尼,达到所设定浓度即行手术。记录术前术中生命体征、抑制牵拉反应、镇静评分、母婴血气等。结果与C组比较,R2、R3、R4组的镇静评分,R3、R4组的抑制牵拉反应,R2、R3、R4组母婴血气结果 pH、二氧化碳分压值差异均有统计学意义(P<0.05);R4组心律T_1比T_0降低,差异有统计学意义(P<0.05)。新生儿1min Apgar评分均≥8分。均无肌僵,心动过缓,无明显呼吸抑制,血氧饱和度均≥98%。结论应用靶控输注1.5～2.0μg/L瑞芬太尼辅助硬膜外阻滞麻醉行剖宫产术,可不同程度的减轻或抑制术中牵拉反应,对产妇有一定的镇静作用,无明显呼吸抑制,对母婴是安全的。

Objective To investigate the feasibility of epidural anesthesia with target controlled infusion (TCI) of remifentanil in cesarean section.Methods One hundred full-term parturients with ASA Ⅰ～Ⅱ requiring cesarean section under epidural anesthesia were randomized into 5 groups,C group is blank control,and experimental group were R1(1.0μg/L), R2 (1.5μg/L),R3 (2.0μg/L) and R4(2.5μg/L) according to the target controlled dose of remifentanil in blood plasma.The algesia block level reached T_6～T_8 was satisfied.At the beginning of operation,the target controlled dose of remifentanil in blood plasma reached reservation test dose.Life symptom,inhibitory traction response,calm score,blood gas analysis of mother's and neonate's were recorded before and after born.Results Compared with group C,the calm scores in group R2,R3,R4,the inhibitory traction response in R3,R4 and the PH/PaCO_2 in R2,R3,R4 had significant differences( P <0.05).The heart rate of R4 in T_1 was significantly lower than that of T_0.The Apgar score of neonate was above 8 at the first minute.There were no muscular rigidity and bradyrhythmia.The SpO_2 was all above 98%.Conclusion TCI remifentanil (1.5～2.0μg/L)had a well calming influence and inhibitory traction response on puerpera and can be safely applied to epidural anesthesia in cesarean section.