舒芬太尼复合罗哌卡因硬膜外麻醉用于急诊剖宫产效果观察

The clinical effect of sufentanil combined with ropivacaine epidural anesthesia in emergency caesarean section

目的:探讨不同剂量舒芬太尼联合罗哌卡因硬膜外麻醉用于急诊剖宫产术效果与不良反应。方法:120例产妇随机分为A、B、C组,每组40例,均行硬膜外麻醉。A组予舒芬太尼10μg(1 ml)+0.5%罗哌卡因15 ml,B组予舒芬太尼15μg 1 ml+0.5%罗哌卡因15 ml,C组给予0.9%氯化钠注射液1 ml+0.5%罗哌卡因15 ml。观察术中胎儿娩出后Apgar评分,起效、无痛平面、镇痛持续时间,改良Bromage评分,视觉模拟评分(VAS)及不良反应。结果:与C组比较,A、B组起效时间、无痛平面时间、感觉阻滞达最高平面时间均缩短(P<0.01),镇痛持续时间均延长(P<0.01)。3组在切皮时VAS差异无统计学意义(P>0.05),3组在探查、取胎时的VAS和寒颤发生率差异均有统计学意义(P<0.01),3组患者术中低血压、心动过缓、恶心、呕吐和瘙痒的发生率差异均无统计学意义(P>0.05);胎儿娩出后Apgar评分差异无统计学意义(P>0.05)。结论:在硬膜外麻醉行剖宫产术时使用罗哌卡因复合舒芬太尼可增强麻醉效果,15μg舒芬太尼复合罗哌卡因硬膜外麻醉可减轻探查取胎时内脏牵拉不适症状,减少术中寒颤的发生率。

Objective：To investigate the effects and adverse reactions of different dosage of sufentanil combined with ropivacaine epidural anesthesia in caesarean section. Methods：One hundred and twenty puerperas were randomly divided into 3 groups（A, B and C group,40 cases in each group）. Group A,B and C were treated with 0.5% ropivacaine for 15 ml combined with 10 μg sufentanil for 1 ml,0.5% ropivacaine for 15 ml combined with 15 μg sufentanil for 1 ml and 0.5% ropivacaine for 15 ml combined with 0.9% sodium chloride injection for 1 ml, respectively. The fetal Apgar score after delivery, onset of action, painless plane, improved Bromage score, visual analogue scale（VAS） and adverse reactions in three groups were observed. Results：Compared with the group C, the onset of action,painless plane time and the highest plane time in group A and B were significantly shortened（P 〈 0.01 ）, the duration of analgesia in group A and B was significantly prolonged（P 〈 0.01 ）. The differences of VAS score between three groups at cutting skin were not statistically significant（P 〉0.05）. The differences of VAS score at exploration and delivery and incidence of shiver between three groups were statistically significant （P 〈 0. 01 ）. The differences of the incidence of intraoperative hypotension, bradycardia, nausea, vomiting and itching between three groups were not statistically significant （ P 〉 0.05 ）, the difference of Apgar score after delivery of the fetus was not statistically significant（ P 〉 0.05 ）. Conclusions：The application of ropivacaine combined with sufentanil in caesarean section under epidural block can significantly enhance the effect of anesthesia, and relieve viscera retracting discomfortable symptoms and reduce the incidence of shiver.