子宫切除术病人不同剂量舒芬太尼混合罗哌卡因硬膜外麻醉的效果

Anesthetic efficacy of epidural ropivacaine mixed with different doses of snfentanil for hysterectomy

目的比较子宫切除术病人不同剂量舒芬太尼混合罗哌卡因硬膜外麻醉的效果。方法择期行子宫切除术病人80例,ASA Ⅰ或Ⅱ级,年龄30-55岁,随机分为四组:罗哌卡因组(L组)、罗哌卡因分别混合舒芬太尼10、20、30μg组(S1、S2、S3组),每组20例。L组硬膜外注入0．75％罗哌卡因13 ml混合生理盐水2 ml,S1、S2、S3组0．75％罗哌卡因13 ml分别混合舒芬太尼10、20、30μg(均为2 ml)硬膜外注入。记录感觉阻滞的起效时间、持续时间、最高平面及达最高平面的时间、运动阻滞的起效时间及持续时间;评价腹部运动阻滞、麻醉效果及不良反应。采用概率单位回归分析建立0．75％罗哌卡因混合不同剂量舒芬太尼硬膜外麻醉的量-效关系方程,计算ED50和ED95。结果与L组比较,S1、S2、S3组感觉阻滞的起效时间及达最高平面的时间缩短,持续时间延长,最高平面升高,腹肌运动阻滞和麻醉效果改善(P<0．05);以S2、S3组麻醉的效果较好,但与其他各组相比,S3组嗜睡、寒战、恶心呕吐的发生率最高(P<0．01);各组间下肢运动阻滞的起效时间、持续时间及Bromage评分比较差异无统计学意义(P>0．05),硬膜外0．75％罗哌卡因混合不同剂量舒芬太尼的ED50为11．21μg (95％可信区间为8．42-13．45μg),ED95为22．16μg(95％可信区间为17．63-38．11μg)。结论子宫切除术病人混合20,30μg舒芬太尼均可增强0．75％罗哌卡因硬膜外麻醉的效果。

Objective To assess the efficacy of ropivacaine in combination with different doses of sufentanil for epidural anesthesia in patients undergoing hysterectomy. Methods Eighty ASA Ⅰ or Ⅱ patients aged 30-55 yrs weighing 40-70 kg undergoing elective hysterectomy were randomly divided into 4 groups （ n = 20 each） ： ropivacaine group （R） and 3 ropivacaine-sufentanil groups （ R-S1-3 ） . The patients were unpremedicated. ECG, BP, HR and SpO2 were monitored during ansthesia. Each patient received an epidural catheter placed at L2.3 interspace. After correct placement of epidural catheter was confirmed 0.75 % ropivacaine 13 ml and normal saline （NS） 2 ml were given through epidural catheter in group R whereas in the 3 R-S groups 0.75% ropivacaine 13 ml and sufentanil 10 （R-S1）, 20 （ R-S2 ） or 30 （R-S3） μg in NS 2 ml were injected into epidural space. BP, HR and SpO2 were recorded every 3 min. The onset time, upper spread and duration of sensory block; onset and duration of motor block （Bromage scale）; degree of abdominal muscle relaxation; level of sedation （OAA/S scale）; anesthetic efficacy and side-effects were recorded. The dose-response curve constructed by probit regression analysis was established to calculate ED50 and ED95. Results The onset time, the time needed to reach the highest sensory level were significantly shorter and the duration of sensory block was significantly longer in the 3 R-S groups than in R group （P 〈 0.05 ） . The degree of abdominal muscle relaxation and the analgesic efficacy were significantly better in group R-S2 and R-S3 than in group R and R-S1. However the incidence of side-effects was highest in group R-S3 . There was no significant difference in motor block among the 4 groups. The ED50 of epidural sufentanil when combined with 0.75% ropivacaine was 11.21 μg （95% CI was 8.42-13.45 μg） and ED95 was 22.16 μg（95 % CI was 17.63-38.11 μg）. Conclusion The anesthetic efficacy of epidural 0.75 % ropivacaine is significantly enhanced when sufentanil 20-30 μg is added.