舒芬太尼复合罗哌卡因用于剖宫产术后镇痛的临床观察

The observation on effect of sufentanil combined with ropivacaine for postoperative analgesia after cesarean section

目的探求舒芬太尼复合罗哌卡因用于剖宫产术后硬膜外患者自控镇痛(PCEA)的较合适的浓度。方法 180例ASAⅠ～Ⅱ级的择期行剖宫产术的单胎足月初产妇,随机分为9组,每组20例(n=20),各组术后行PCEA,舒芬太尼3种浓度(0.5μg.mL-1、0.75μg.mL-1、1.0μg.mL-1)和罗哌卡因3种浓度(0.10%、0.125%、0.15%)贯序组合为9种配比,0.5μg.mL-1舒芬太尼+0.10%罗哌卡因组简写为(0.5S+0.10L)组,其他各组相应地简写为(0.5S+0.125L)组,(0.5S+0.15L)组,(0.75S+0.10L)组,(0.75S+0.125L)组,(0.75S+0.15L)组,(1.0S+0.10L)组,(1.0S+0.125L)组,(1.0S+0.15L)组。PCEA镇痛模式为:背景剂量2mL.h-1,PCA 0.5mL/次,锁定时间15min。术后4、8、20、24、48h观察镇静效果,并在平静状态下进行视觉模拟评分(VAS),记录血压、脉搏和呼吸频率的变化、镇痛泵使用情况以及恶心、呕吐、瘙痒、尿潴留、麻木等不良反应或不适。结果随着舒芬太尼或者罗哌卡因的浓度增高,镇痛效果相应增强,VAS评分降低,但是相应出现的臀部或者大腿麻痹不适感比例也增加;(0.75S+0.125L)组、(0.75S+0.15L)组、(1.0S+0.125L)组、(1.0S+0.15L)组的镇痛效果均较理想,但4组的VAS评分无显著差异(P>0.05)。结论 0.75μg.mL-1舒芬太尼复合0.125%罗哌卡因、2mL.h-1的镇痛方案适合于剖宫产术后的硬膜外镇痛,镇痛效果理想,且不良反应较少。

OBJECTIVE To find the optimal concentration of sufentanil combined with ropivacaine for postoperative self-controlled epidural analgesia after cesarean section.METHODS 180 nulliparous women with singleton pregnancies at term graded ASAⅠ～Ⅱ undergoing elective cesarean section were randomly divided into nine grouds（n=20 in each groud）,every groud received patient-controlled epidural analgesia（PCEA）,three concentrations of sufentanil（0.5μg·mL-1、0.75μg·mL-1、1.0μg·mL-1）matched three concentrations of ropivacaine（0.10%、0.125%、0.15%）which formed nine grouds,the groud 0.5μg·mL-1 sufentanil with ropivacaine 0.10% abbreviated as 0.5S＋0.10L,similarly,the else grouds abbreviated as（0.5S＋0.125L）,（0.5S＋0.15L）,（0.75S＋0.10L）,（0.75S＋0.125L）,（0.75S＋0.15L）,（1.0S＋0.10L）,（1.0S＋0.125L）,（1.0S＋0.15L）.PCEA include background 2mL·h-1 and bolus of 0.5mL with a 8min lockout time.postoperative analgesia was assessed by recording the patient-controlled analgesia device and the patients,visual analog scale（VAS） at 4h,8h,20h,24h,48h after operation.Sedation analog scales and side effects were also recorded.RESULTS As the rose in concentration of sufentanil or ropivacaine,the analgesic effect strengthened,VAS cores dropped,but the rate of numbness in the thighs and buttocks rose;the analgesic effect in groud（0.75S＋0.125L）,（0.75S＋0.15L）,（1.0S＋0.125L）,and（1.0S＋0.15L） all were satisfactory,while the VAS cores of the four grouds had no significant differences（P0.05）.CONCLUSION 0.75μg·mL-1 sufentanil combined with ropivacaine 0.125% with continuous background infusion of 2mL·h-1 is effective for postoperative epidural analgesia after cesarean section,which has satisfactory analgesic effect and less side effects.