左旋布比卡因复合舒芬太尼硬膜外麻醉在剖宫产术中的应用

Efficacy and safety of the epidural anesthesia using low-dose sufentanil combined levobupivacaine in obstetric surgery

目的探讨小剂量舒芬太尼复合左旋布比卡因硬膜外麻醉用于产科手术的临床疗效及安全性。方法选择60例ASAI～Ⅱ级的剖宫产产妇,随机分为S和B两组,每组各30例。S组给予0.5%左旋布比卡因13ml加舒芬太尼20ug(1m1),B组给予0.5%左旋布比卡因13ml加生理盐水1ml。术中连续监测呼吸和循环状况,评估麻醉效果、不良反应和新生儿情况。结果 S组的感觉阻滞起效时间,平面达T10的时间及达到最高阻滞平面的时间均明显短于B组(P<0.01);S组最高阻滞平面明显高于B组(P<0.01),两组不良反应、Apgar评分差异无统计学意义(P>0.01)。结论剖宫产手术产妇硬膜外左旋布比卡因复合小剂量舒芬太尼的麻醉效果明显优于单纯应用左旋布比卡因,对新生儿Apgar评分无明显影响。

Objective To investigate the efficacy and safety of the epidural anesthesia using low-dose sufentanil combined levobupivacaine in obstetric surgery.Methods 60 patients,ASA class Ⅰ-Ⅱ parturient undergoing caesarean section,were randomly divided into two groups,S and B,using 13ml of 0.5% levobupivacaine and 20μg（1ml） sufentanil in group S while using 13ml of 0.5% levobupivacaine and saline 1 ml in group B.To continuously monitor the respiratory and the circulatory conditions of the parturient and estimate the anesthesia condition,adverse reaction and the neonates during the surgery.Results Compared with group B,obviously group S has earlier onset time of sensory block,the shorter time of anesthesia level to T10,as well as the shorter time of reaching to the highest nerve block level（P〈0.01）;Beside that,the highest level of block in group S was significantly higher than that in group B（P〈0.01）.There was no statistical significance about the adverse reaction and the difference in Apgar evaluation.Conclusion The anesthesia effect of those parturient who received low-dose sufentanil combined levobupivacaine is obviously much better than those who only received levobupivacaine,no significant effect on Neonatal Apgar Score.