左旋布比卡因复合芬太尼和舒芬太尼腰硬联合麻醉用于剖宫产手术的观察研究

The Study on Levobupivacaine with Fentanyl and Sufentanil in Combined Spinal and Epidural Anesthesia in Cesarean Section.

目的观察重比重左旋布比卡因复合芬太尼和舒芬太尼蛛网膜下腔麻醉(以下简称腰麻)联合硬膜外麻醉(CE-SA)用于剖宫产手术的效用。方法择期单胎足月剖宫产手术患者90例,随机分为3组,每组30例。重比重腰麻液配置A组:左旋布比卡因10mg;B组:左旋布比卡因7.5mg+芬太尼20μg;C组:左旋布比卡因7.5mg+舒芬太尼5μg。观察3组患者的腰麻阻滞效果、血流动力学变化、牵拉反应程度及新生儿娩出后1、5min时的Apgar评分,观察瘙痒、恶心呕吐等不良反应的发生。结果 B组术中心动过缓和低血压人数少于A组(P<0.05),C组低血压人数少于A组(P<0.05)。运动神经阻滞恢复时间B、C两组快于A组;感觉阻滞恢复时间B、C两组慢于A组(P<0.05),且B组慢于C组(P<0.01);最高感觉阻滞平面、到达最高阻滞平面时间、运动阻滞起效时间、达最大运动阻滞时间、改良B rom age评分3组间无明显差异(P>0.05)。3组间牵拉反应程度、瘙痒、恶心呕吐的发生、新生儿的Apgar评分均无统计学差异(P>0.05)。结论 7.5mg重比重左旋布比卡因伍用芬太尼20μg或舒芬太尼5μg腰麻联合硬膜外麻醉用于剖宫产手术,均能获得良好的感觉和运动阻滞效果,血流动力学更平稳;与10mg重比重左旋布比卡因相比运动阻滞恢复快,感觉阻滞恢复慢,伍用芬太尼20μg时尤为明显,利于产妇早期活动,值得临床推广应用。

Objective To observe the efficiency of hyperbaric levobupivacaine combined with fentanyl and sufentanil for combined spinal epidural anesthesia（CESA） in cesarean section.Methods 90 nulliparous women with a singleton full-term pregnancy scheduled for caesarean section,were randomly divided into 3 groups with 30 patients in each group（group A,B,C）.Patients in group A received spinal anesthesia fluid of hyperbaric levobupivacaine 10mg,in group B hyperbaric levobupivacaine 7.5mg ＋ fentanyl 20μg,and in group C hyperbaric levobupivacaine 7.5mg ＋ sufentanil 5 μg.The effect of spinal anesthesia,hemodynamics,the incidence of itch,nausea and vomiting,and Apgar scores of the newborn were observed.Results The incidence of hypotension and bradyarrhythmia in group B was lower than that in group A and the incidence of hypotension in group C was lower than that in group A（P〉0.05）.Duration of motor block in group B and C was significantly shorter than that in group A（P〉0.05）.Duration of analgesia in group B and C was significantly longer than that in group A（P〉0.05）and longer in group B than group C（P〉0.05）.There was no significant diference in the other parameters of anesthetic effect among the three groups.There was no significant diference in the incidence of itch,nausea and vomiting,and Apgar scores of the newborn among the three groups.Conclusion CESA with 7.5mg hyperbaric levobupivacaine combined with fentanyl 20μg or sufentanil 5μg spinal epidural anesthesia in cesarean section,can get a good effect of sensory and motor block,smooth hemodynamic,with rapid recovery of motor block and slow recovery of sensory block compared with 10mg hyperbaric levobupivacaine.It is particularly evident with 20μg fentanyl,which will help mothers to take early activity,and be worthy of clinical application.