舒芬太尼、芬太尼复合0.2%甲磺酸罗哌卡因对剖宫产术后镇痛的效果观察

Efficacy of Epidural Sufentanil or Fentanyl Combined with 0.2% Ropivacaine Mesylate for Post-caesarean Analgesia

目的：探讨舒芬太尼、芬太尼复合0.2%甲磺酸罗哌卡因对剖宫产术后硬膜外自控镇痛效果。方法拟行剖宫产术90例，ASAⅠ~Ⅱ级20~32岁，体质量55~90 kg，分为三组，每组30例。罗哌卡因组（L组）：0.2%甲磺酸罗哌卡因100 mL；罗哌卡因-芬太尼组（LF组）：0.2%甲磺酸罗哌卡因100 mL＋芬太尼5μg/mL；罗哌卡因-舒芬太尼组（LS组）：0.2%甲磺酸罗哌卡因100 mL＋舒芬太尼0.5μg/mL。持续输注剂量2 mL/h，PCA量0.5 mL，锁定时间15 min。采用视觉模拟评分法（visual analogue scale,VAS）观察镇痛效果；观察下肢运动阻滞情况；观察恶心、呕吐、低血压、皮肤瘙痒情况。结果①LS组与LF组术后8、12、24 hVAS评分低于L组（P＜0.05），LS组与LF组VAS评分无统计学意义（P＞0.05）。②术后2、4 h，各组Bromage评分均高于其余时点（P＜0.05）；其余时点进行比较，各组间及组内比较均无统计学意义（P＞0.05）。③各组恶心呕吐、低血压无统计学意义（P＞0.05）；LS组与L组皮肤瘙痒低于LF组（P＜0.05）。结论硬膜外舒芬太尼、芬太尼复合0.2%甲磺酸罗哌卡因均可为剖宫产术后提供良好镇痛效果，但舒芬太尼皮肤瘙痒发生率低。

Objective To evaluate the efifcacy of epidural sufentanil or fentanyl combined with 0.2%ropivacaine for post-caesarean analgesia. Method The 90 ASAⅠorⅡpatients aged 20~32 years old weighing 55~90 kg undergoing caesarean section were randomly divived into 3 groups（n=30）：L group （ropivacaine mesylate） received 0.2% ropivacaine mesylate 100 mL;LF group （ropivacaine mesylate-fentanyl） received 0.2% ropivacaine mesylate 100 mL and fentanyl 5 μg/mL;LS group （ropivacaine mesylate-sufentanil） received 0.2%ropivacaine mesylate 100 mL and sufentanil 0.5 μg/mL. The PCEA （patient-controlled epidural analgesia） pump was programmed to deliver a 2 mL bolus with lockout interval 15 min and backgound infusion of 2 mL/h. Postoperative pain scores were evaluated using VAS （visual analog scale, 0-10）. Motor block were evaluated using Bromage scale. Side effect such as nausea, vomiting, pruritus and hypotension were recorded. Results①The value of VAS in LS group and LF group were signiifcantly lower in L group at 8, 12, 24 h post-caesarean（P〈0.05）. There is no different in LS group and LF group（P〉0.05）.②The value of Bromage scale at 2, 4 h were higher than at other time post-caesarean in the three groups（P〈0.05）.③The incidence of pruritus in LS group and L group was signiifcantly lower than in LF group（P〈0.05）. There were no different on incidences of nausea, vomiting and hypotension in three groups（P〉0.05）. Conclusion The combination of epidural sufentanil or fentanyl with 0.2%ropivacaine can provide sufifcient analgesia and less pruritus in sufentanil for post-caesarean.