小剂量布比卡因复合舒芬太尼或芬太尼腰硬联合麻醉用于剖宫产手术的比较

Comparison of intrathecal fentanyl and sufentanil in low-dose diluted bupivacaine spinal epidural anesthesia for cesarean delivery

目的:旨在观察并比较鞘内注射舒芬太尼或芬太尼复合小剂量布比卡因用于择期剖宫产手术中的有效性及安全性。方法:60名施行择期剖宫产手术患者被随机分为舒芬太尼组(S组)和芬太尼组(F组),每组30例。S组:0.75%布比卡因1 ml+舒芬太尼5μg+脑脊液稀释至2 ml,蛛网膜下腔注射;F组:0.75%布比卡因1 ml+芬太尼20μg+脑脊液稀释至2 ml,蛛网膜下腔注射,于注药前及注药后各时点记录术中的收缩压(SBP),舒张压(DBP),心率(HR),呼吸频率(RR),血氧饱和度(SpO2)。分别评估两组感觉阻滞起效时间以及持续时间,感觉阻滞最高平面,运动阻滞程度,术后24 h内VAS评分以及不良反应情况。结果:两组在注药后1 min、3 min、5 min、10 min、15 min的收缩压,舒张压,心率,呼吸频率以及血氧饱和度无明显差异(P>0.05)。S组感觉阻滞起效时间较F组缩短(P<0.01),感觉阻滞持续时间延长(P<0.01);S组感觉阻滞最高平面高于F组(P<0.05),S组术后镇痛时间长于F组(P<0.05)。两组在运动阻滞,不良反应方面无明显差异。结论:小剂量布比卡因复合20μg芬太尼或者5μg舒芬太尼腰硬联合麻醉可以为剖宫产手术提供足够的镇痛与肌松,较少的血流动力学波动,提高麻醉的安全性与精准性。舒芬太尼易于使麻醉平面扩散并产生更好的术后镇痛效应,其麻醉效果优于芬太尼。

Objective：To compare the safety and efficacy of combined intrathecal fentanyl or sufentanil with low-dose bupivacaine for uterine-incision delivery.Methods：Sixty parturients undergoing elective caesarean delivery were included and allocated into two groups.Group F（n=30） received fentanyl 20 μg ＋ bupivacaine 0.75%（1.0 ml） with cerebrospinal fluid（CSF） diluted to 2.0 ml and Group S（n=30） were intrathecally given sufentanil 5 μg＋bupivacaine 0.75%（1.0 ml） diluted to 2.0 ml in total by CSF.The data were kept concerning systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）,respiratory rate（RR） and SpO2 before surgery and intraoperative time points,and two groups were assessed regarding onset and duration of sensory and motor block,sensory block peak level,adverse events and postoperative visual analogue scale（VAS） in 24 hours.Results：The two groups had no significant different with respect to SBP,DBP,HR,RR and SpO2 at 1,3,5,10 or 15 min after analgesics（P0.05）.Earlier sensory block,higher median peak level and longer duration of the sensory block as well as postoperative analgesia were seen in group S as compared with group F（P0.01,P0.05）,and yet,no significant difference was found between the groups regarding the degree of motor block,anesthetic effects and adverse events.Conclusion：Low-dose diluted bupivacaine with fentanyl 20 μg or sufentanil 5 μg intrathecal can safely and effectively provide anesthesia and muscle relaxant without haemodynamic instability for cesarean section delivery in parturients.However,sufentanil appeared to produce superior quality of spinal block and postoperative analgesia to that fentanyl did.