不同剂量舒芬太尼鞘内注射对剖宫产术后镇痛效果的影响

Effect of intrathecal sufentanil injection on postoperative analgesia of cesarean section

目的探讨舒芬太尼鞘内注射对产妇的术后镇痛效果的影响及舒芬太尼用于鞘内注射的最佳剂量。方法选择160例ASAⅠ~Ⅱ级足月妊娠行剖宫产手术的产妇,随机分成4组（每组40例）实施腰-硬联合麻醉（CSEA）。对照组（A组）用0.75%的布比卡因1.1 ml（8.25 mg）;舒芬太尼依据在对照组基础上加用剂量不同分为B组（4μg）、C组（6μg）、D组（8μg）。评价术后新生儿情况、术后VAS评分及不良反应。结果各组新生儿1 min和5 min时Apgar评分在正常范围（P〉0.05）;与A组比较,B、C、D组术后无痛时限明显延长（P〈0.0 5）;术后C组和D组相比,D组无痛时限没有明显延长（P〉0.0 5）。术后各组恶心呕吐及皮肤瘙痒与剂量相关,B组、C组和D组病例的恶心呕吐、皮肤瘙痒发生率都明显高于对照组（P〈0.0 5）,B、C、D3组比较,差异有显著性（P〈0.05）。结论舒芬太尼鞘内注射能有效延长剖宫产术后镇痛时间,对新生儿无不良影响,具有良好的安全性,但对产妇有一定的不良反应。其舒芬太尼的最佳剂量为6μg。

Objective To observe the effect of intrathecal sufentanil injection on postoperative analgesia of cesarean section.Methods 160 cases of full-term pregnancy parturients with ASA gradeⅠtoⅡwere chosen to perform cesarean section.They were randomly divided into 4 groups（each including 40 cases） for lumbar anesthesia.Group A served as a control in which 1.1ml bupivacaine of 8.25 mg was used.Sufentanil of 4μg,6 μg,8 μg was used in groups B,C and D respectively on the base of group A.The condition of newborn was evaluated.The VAS score after operation and the harmful reaction during cesarean section period were investigated.Results The Apgar score of newborns at 1 min or 5 min in each group was normal（P0.05）.Compared with group A,the span of effective analgesia after operation in each sufentanil group was markedly increased（P0.05）.Compared with group C,the painless time in group D time was not significantly prolonged（P 0.05）.In each sufentanil group,there was a correlation between the post-operation harmful reaction（such as cutaneous pruritus,nausea,vomiting）and the dosage.In groups B,C and D,the number of cutaneous pruritus,nausea and vomiting was markedly higher than in group A（P0.05）.For groups B,C and D,the difference was significant.（P 0.05）.Conclusion Sufentanil can be safely used in cesarean section and has no bad effect on the newborn.The intrathecal sufentanil of 6 μg is advisable for the postoperative analgesia.