小剂量罗哌卡因复合芬太尼或舒芬太尼腰硬联合麻醉行阴式子宫切除术

Comparison of Intrathecal Fentanyl and Sufentanil in Low-dose Ropivacaine Spinal Anaesthesia for Transvaginal Hysterectomy

目的比较腰硬联合麻醉低剂量的罗哌卡因与芬太尼或舒芬太尼联合应用于阴式子宫切除术的麻醉效果。方法将45例行阴式子宫切除术的病人随机分为L、F和S三组,每组15例。L组腰麻用药为罗哌卡因15mg,F组腰麻用药为罗哌卡因7.5mg与芬太尼25μg,S组罗哌卡因7.5mg与舒芬太尼5μg。观察感觉阻滞起效时间,痛觉阻滞持续时间,最高阻滞平面、三组最大运动阻滞Bromage评分及血液动力学的变化。结果 F组和S组的感觉阻滞起效时间均短于L组(P<0.05);感觉阻滞持续时间F组和S组均明显长于L组(P<0.05),且S组明显长于F组(P<0.05)。L组的感觉阻滞最高平面稍高于F组和S组,但差异无统计学意义(P>0.05)。F组和S组最大运动阻滞Bromage评分均明显小于L组(P<0.05)。L组患者麻醉后5～10minMAP明显降低,与麻醉前相比P<0.05。L组有三例患者出现恶心,F组有两例患者出现恶心,S组未出现这种情况。结论实施阴式子宫切除术,小剂量罗哌卡因与25μg芬太尼或舒芬太尼5μg联合使用行腰硬联合麻醉能提供有效的麻醉,且舒芬太尼优于芬太尼。

Objective To evaluate the effect of low dose ropivacaine fentanil or sufentanil used to combined spinal and eqidual anesthesia （CESA） in transvaginal hysterectomy. Methods Fortyfive patients undergoing transvaginal hysterectomy were divided into three groups randomly （each n - 15）. Ropivacaine 15 mg was given in subarachnoid space in group L. Ropivacaine 7.5 mg and fentanil 25 lag were given in subarachnoid space in group F. Ropivacaine 7 .5 mg and sufentanil 5 μg were given in subarachnoid space in group S. The onset time of sensory block, the duration of sensory block, the height of block, Bromage scale, HR and MAP were observed and recorded. Results Compared with group L, the onset time and the Bromage scale in group S and group F were significantly decreased （P 〈 0.05, P 〈 0.05）. No significant changes in peak level of the sensory block were observed within the three groups （P 〉 0.05）. Duration of analgesia in group S was significantly increased compared with that in group F （P 〈 0.05）. No statistically significant difference was found in the maximal sensory block plane between group L and group F or group S （P〉0.05）. The MAP at 5-10 min after anesthesiain was significantly decreased as compared with that before anesthesia in group L （P〈0.0.5）. Nausea occurred in 3 patients of group L and 2 patients of group F, but not in group S. Conclusions Lowdose diluted ropivacaine with fentanyl 25 lag or sufentanil 5 lag can provide adequate anaesthesia without haemodynamic instability for transvaginal hysterectomy. Sufentanil is superior to fentanyl in the quality of the spinal block produced.