甲磺酸罗哌卡因复合舒芬太尼用于剖宫产术后镇痛浓度的临床研究

The clinical research on concentration of ropivacaine mesylate combined with sufentanil in postoperative analgesia after caesarean section

目的观察舒芬太尼复合不同浓度的甲磺酸罗哌卡因用于剖宫产术后硬膜外自控镇痛术(PCEA)的效果及甲磺酸罗哌卡因的最佳有效浓度。方法 90例产妇在硬-腰联合麻醉(CSEA)下行剖宫产手术的患者,手术后行PCEA术后镇痛,在同样的阿片类药物剂量(30μg舒芬太尼)的背景下,依照给予不同浓度的甲磺酸罗哌卡因,随机分为3组;A组(n=30),0.2℅甲磺酸罗哌卡因100 ml;B组(n=30),0.15℅甲磺酸罗哌卡因100 ml;C组(n=30),0.1℅甲磺酸罗哌卡因100 ml。观察指标:术后4 h、12 h、48 h患者VAS疼痛评分,改良Bromage评分,恶心、呕吐、瘙痒、尿潴留、排气时间延长、延迟性呼吸抑制等副作用。结果①不同浓度的罗哌卡因各时间点VAS无统计学差异(P>0.05)。②下肢肌力恢复情况:术后4 h结果显示,3组间差异无统计学意义(P>0.05)。手术后12 h和48 h显示,C组与A、B两组相比,对下肢肌力影响最小,差异有统计学意义(P<0.05)。③在副作用项目中,C组在尿潴留、排气时间延长上与其它两组比较发生率明显减低,差异有统计学意义(P<0.05)。结论 0.1℅甲磺酸罗哌卡因复合枸橼酸舒芬太尼用于剖宫产术后镇痛效果良好,副作用少,且运动阻滞程度最小,因此更适合应用于剖宫产术后PCEA术后镇痛。

Objective To explore the effect of sufentanil combined with ropivacaine mesylate in different concentration for patient con- trolled epidural analgesia （PCEA） in women after caesarean section （CS） and to find the optimal effective concentration of ropivacaine mesylate. Methods Ninety women accepting PCEA with sufentanil and ropivacaine mesylate after CS under combined spinal and epidural anesthesia （CSEA） were randomly divided into groups of receiving 0.2% ropivacaine mesylate 100ml （group A, n = 30 ）, 0.15% ropivacaine mesylate lO0ml （ group B, n = 30） and 0.1% ropivacaine mesylate 10Oral （ group C, n = 30）. Visual analogue scale （VAS） in postoperative 4 h, 12 h and 48 h, modified Bromage score （MBS） , and side effects such as nausea, vomiting, pruritus, retention of urine, postponed anus exhausting time, and delayed onset of respiratory depression were observed. Results There was no significant difference in VAS at postoperative period a- mong three groups （ P 〉 0.05 ）. There was no significant difference in MBS at postoperative 4h among three groups （ P 〉 0.05 ） but MBS at post- operative 12h and 48h were significantly lower than those in group A and B （ P 〈0.05 ）. Significantly lower incidence of retention of urine and postponed anus exhausting time were found in group C （ P 〈 0.05 ）. Conclusion 0.1% ropivacaine mesylate combined with sufentanil is the most suitable for PCEA in women after CS because it is effective in postoperative analgesia, and has lower influence on motor block and fewer side effects than those in ropivacaine mesylate combined with sufentanil in other concentration.