舒芬太尼或曲马多复合罗哌卡因在剖宫产术后硬膜外镇痛中的比较观察

Comparison of Sufentanil or Tramadol Combined with Ropivacaine for PCEA After Cesarean Section

【目的】比较观察舒芬太尼或曲马多分别复合罗哌卡因用于剖宫产术后硬膜外自控镇痛（PECA）的效果及对催乳素的影响。【方法】选择120例择期行剖宫产的孕妇，随机分为舒芬太尼组（S组）和曲马多组（T组），术毕行PCEA48h，S组用0．15％罗哌卡因＋0．4μg／mL舒芬太尼，T组用0．15％罗哌卡因＋4mg／mL曲马多。观察记录两组孕妇的总用药量、追加（Bonus）次数、各时段[1h（T1），6h（T2），12h（T3），24h（T4），48h（T5）]视觉模拟评分法（VAS）评分、改良运动阻滞评分（Ramsay）评分、改良Bromage评分、不良反应发生情况及血清催乳素（PRL）浓度变化。【结果】S组总用药量及Bonus次数均小于T组（P〈0．05），T2～T5时点S组VAS评分低于T组（P〈0．05），两组Ramsay评分多在2～3分左右，T3～T5时点S组Ram—say评分高于T组（P〈0．05），两组Bromage评分无统计学差异（P〉0．05），两组均无严重并发症发生，T组恶心、呕吐发生率高于S组（P〈0．05），S组皮肤瘙痒发生率高于T组（P〈0．05），两组术后24h及48h血清催乳素浓度均高于术前（P〈0．05），S组升高更为显著（P〈0．05）。【结论】舒芬太尼或曲马多分别复合罗哌卡因用于剖宫产术后PCEA均安全有效，且不良反应较少，舒芬太尼复合罗哌卡因的镇痛效果优于曲马多，且镇静程度较曲马多深，但皮肤瘙痒发生率较高，而恶心、呕吐发生率较低。

[Objective]To compare the effect of sufentanit or tramadol combined with ropivacaine for patient-controlled epidural analgesia （PCEA） after cesarean section and their influence on prolactin （PRL）. [Methods] One hundred and twenty cases of selective cesarean section were divided into sufentanil group （group S） and tramadol group（group T） randomly. PCEA was done after surgery for 48h. Group S was given 0. 15% ropivacaine plus 0.4μg/ml sufentanil, while group T was given 0.15 % ropivacaine plus 4mg/ml tramadol. Total dosage, bonus time, VAS score, Ramsay score, modified Bromage score, adverse effect occur rence and concentration changes of serum PRL were observed. [Results] Total dosage and bonus time of group S were lower than those of group T（ P 〈0. 05）. At T2 -T5, VAS scores of group S were also lower than those of group T（ P 〈0.05）. Ramsay scores of most cases were between 2 to 3. At T3 -T5, Ramsay scores of group S were higher （ P 〈0. 05）, and there was no difference in modified Bromage score between two groups of（ P 〉0.05）. No severe complication was observed. The incidence of nausea and vomiting of group T was higher, while the incidence of itch of skin of group S was higher. Serum PRL in two groups after operation was higher than that before operation, and serum PRL in group S changed more markedly than that in group T. [Conclusion] Sufentanil or tramadol combined with ropivacaine for PCEA after cesarean section is safe and effective, and has less adverse effect. The analgesia effect of sufentanil is stronger than that of tramadol, and its sedative effect was deeper than that of tramodoh Nevertheless, sufentanii has higher incidence of itch of skin and lower incidence of nausea and vomiting.