小剂量罗哌卡因复合舒芬太尼腰硬联合麻醉用于剖宫产术效果的多方面评价

Effect of low-dose ropivacaine-sufentanil in spinal anesthesia for cesarean delivery

目的:探讨小剂量罗哌卡因复合舒芬太尼腰硬联合麻醉用于剖宫产术的感觉、运动阻滞效果及不良反应,并与布比卡因及罗哌卡因比较。方法:择期在腰硬联合麻醉下行剖宫产术的产妇66例,按不同麻醉药物分为B组(布比卡因8mg)、R组(罗哌卡因12mg)、RS组(罗哌卡因9mg复合舒芬太尼5μg)3组。观察记录麻醉前、注入麻醉药后基本生命体征,感觉阻滞及运动神经阻滞情况及术中的不良事件发生率。结果:B组血流动力学波动最大,R组波动较B组稍小,但与B组无明显差异,RS组波动最小,与B组有明显差异(P<0.05)。RS组感觉阻滞效果最佳,B组次之,R组最差。B组较其余两组运动阻滞程度高,恢复时间长(P<0.05),RS组运动阻滞程度与R组无明显差异,但恢复最快(P<0.05)。RS组患者有明显的镇静表现,镇静评分较其余两组高(P<0.05),B、R组未出现明显镇静。RS组恶心、呕吐、寒战、术中牵拉痛发生率明显低于B组(P<0.05),但瘙痒发生率高于B、R组(P<0.05)。结论:剖宫产患者罗哌卡因9mg复合舒芬太尼5μg腰硬联合麻醉有良好的镇痛及肌松效果,且患者血流动力学平稳,术后肌松恢复迅速,术中不良反应少,并可以起到一定的术后镇痛作用,值得临床推广。

Objective： To explore the effect of low-dose ropivacaine combined with sufentanil in spinal anesthesia for cesarean section and evaluate its sensory-motor block effects and adverse reactions, in comparison with use of bupivacaine and ropivacaine, respectively. Methods： Sixty six cases of elective cesarean section under spinal or combined spinal-epidural anesthesia were divided into three groups： Group B （bupivacaine 8 mg）, Group R （ ropivacaine 12 mg）, Group RS （ Ropivacaine 9 mg＋ Sufentanil 5μg）. Indexes of sensory nerve block and motor nerve block and intraoperative adverse events were observed and recorded. Results： Hemodynamic indexes of Group B was most volatile while that of group RS was most stable, which was significantly different from group B （ P 〈 0. 05）. Sensory nerve block of Group RS was the best, group B followed, and group R was the worst. The motor nerve block was obviously completed and prolonged in Group B than the other two groups （ P 〈 0. 05 ）. The motor nerve block degree of RS Group was similar with Group R, but with faster recovery （P 〈 0. 05 ）. Group RS＇s sedation score were higher than the other two groups （ P 〈 0. 05）. Adverse events incidence of Group RS, such as nausea, vomiting, shiver and traction pain, were significant lower than the other two group （ P 〈 0. 05 ）, while the itching incidence was higher than Group B and R （P 〈 0. 05 ）. Conclusion： Combined use of ropivacaine （9 mg） and sufentanil （5 μg） in spinal anesthesia had perfect tients, with stable hemodynamics, quick postoperative analgesic and muscle relaxant effect for cesarean section pamuscle relaxant and fewer adverse reactions.