异丙酚、氟哌利多用于预防舒芬太尼鞘内注射所致瘙痒的临床研究

Study of the prophylactic effect of droperidol and propofol on spinal Sufentanil-induced pruritus

目的比较小剂量氟哌利多和亚催眠剂量的异丙酚对舒芬太尼鞘内注射所导致的瘙痒的预防和治疗作用,以寻求减少阿片类药物鞘内注射所致瘙痒发生率的有效方法。方法ASAⅠ～Ⅱ级,拟行剖宫产手术的适龄产妇180例,随机分为Ⅰ组(异丙酚组),Ⅱ组(氟哌啶组)和Ⅲ组(对照组)每组60例。于L3～4穿刺,注入0.5%罗哌卡因1.5 ml,舒芬太尼5μg(5μg/ml)和0.9%氯化钠注射液1 ml的混合药液3 ml,腰麻下完成剖宫产手术,待胎儿娩出后,Ⅰ组(异丙酚组)产妇静脉给予异丙酚0.35 mg/kg,Ⅱ组(氟哌啶组)给予氟哌啶0.021 mg/kg,Ⅲ组(对照组)给予生理盐水2 ml。观察并记录患者术后瘙痒和其他不良反应的反生情况。结果I组(异丙酚组),Ⅱ组(氟哌啶组)中度以上瘙痒的发生率明显低于Ⅲ组(对照组)。其中,氟哌啶的NNT值为3.52,95%CI:3.37～3.67。异丙酚的NNT值为4.61,95%CI:4.45～4.77。结论氟哌啶和异丙酚可以有效地减少阿片类药物鞘内注射所引起的瘙痒。

Objective To compared the use of propofol and droperidol for the prevention of spinal Sufentanil-induced pruritus.MethodsOne hundred and eighty ASA I-II women undergoing Caesarean section under spinal anaesthesia,in which Sufentanil 5 μg was added to a local anaesthetic,were assigned randomly to receive intravenous,in the operating room,just after delivery of the baby,propofol 0.35 mg/kg,droperidol 0.021 mg/kg or saline 2 ml（control group）.In the postoperative period,the women were assessed for pruritus（absent,mild,moderate or severe）or other untoward symptoms.ResultsThe droperidol,propofol groups had significantly lower incidences of pruritus compared with the control group.As for the prevention of moderate and severe pruritus,droperidol had the lowest NNT（3.52;95%CI：3.37-3.67）,followed by propofol（4.61;95%CI：4.45-4.77）.ConclusionDroperidol,propofol in a decreasing order of effectiveness in the doses used in this study,reduced the incidence of pruritus induced by the use of Sufentanil 5 μg intrathecally.