舒芬太尼复合罗哌卡因腰麻在二次剖宫产手术中的应用

Applicntion of spinal anesthesia with ropivacaine combined sufentanil in the secondary cesarean

目的探讨舒芬太尼复合罗哌卡因腰麻用于二次剖宫产手术的有效性和安全性。方法选择二次剖宫产手术患者40例,随机分为两组,麻醉方式均采用腰-硬联合麻醉,A组采用0.5%罗哌卡因10mg＋舒芬太尼5μg;B组采用0.5%罗哌卡因12mg腰麻。观察两组患者麻醉前（T_1）、麻醉后5min（T_2）、手术开始（T_3）、擦洗腹腔（T_4）、术毕（T5）时的血流动力学变化以及腰麻后的副反应。结果在血流动力学方面,两组在T_2~T5的MAP比较,差异有统计学意义（P〈0.05）,B组中与T_1时比较,T_2~T5的MAP值均明显降低。在腰麻后副反应中,B组出现牵拉反应及因血压急剧下降需要静注麻黄碱的患者数明显高于A组（P〈0.05）,其余副反应的发生率无统计学意义（P〉0.05）。结论舒芬太尼复合罗哌卡因腰麻可安全有效应用于二次剖宫产手术中,其血流动力学更平稳,镇痛效果更满意,且不良反应少。

Objective To discuss the clinical effectivity and safety of spinal anesthesia with ropivacaine combined sufentanil in the secondary cesarean. Method Forty patients undergoing elective secondary cesarean under CSEA were randomly into two groups. group A received 0.5% ropivacaine 10mg＋sufentantil 5μg.Group B 0.5% ropivacaine 12 mg.The hemodynamic changes at before anesthesia（T_1）,5minute after anesthesia（T_2）,operation beginning（T_3）,scrubbing intraperitoneal（T_4）and the end of operation（T_5）were compared,and side effects were recorded Results The MAP of two groups at T_2-T_5 had significant difference（P〈0.05）.In group B,compared to T_1,MAP were decreased significantly at T_2-T_4. The incidence of traction reaction and hypotension need to intravenous ephedrine in group B was higher than group A（P〉0.05）.There was no significant difference between the two groups（P〈0.05）. Conclusion Ropivacaine combined sufentanil for spinal anesthesia can be effectively and safely for secondary cesarean.and more stable hemodynamics,better analgesic effects and less complications.