小剂量舒芬太尼在剖宫产术腰硬联合麻醉中预防寒颤及牵拉痛的临床观察

Clinical observation of chill and dragging pain prevention in cesarean section waist hard joint anesthesia by small doses Sufentanil

目的探讨小剂量舒芬太尼在剖宫产术腰硬联合麻醉中的临床应用。方法选择2015年3～6月在重庆市妇幼保健院就诊的单纯足月妊娠并行剖宫产手术进行分娩的产妇共80例,均给予腰硬联合麻醉,按麻醉用药分为观察组和对照组,每组各40例。对照组麻醉用药蛛网膜下腔内给予0.75%布比卡因（2.0 mL）和5%葡萄糖（1.0 mL）混合液2.3 mL,观察组在对照组用药基础上蛛网膜下腔内加用舒芬太尼（5μg,0.1 mL）。①比较两组产妇术前、注药后1、3、5、10 min及手术结束时的心率、平均动脉压情况;②比较两组产妇注药后1、5、10 min时最大感觉平面,踝关节的运动恢复时间及手术持续时间;③比较新生儿出生后1、5 min时的Apgar评分情况及寒战和牵拉痛的发生情况。结果①两组产妇术前、注药后1、3、5、10 min及手术结束时的平均动脉压、心率等指标差异均无统计学意义（P〉0.05）。②两组产妇在注药后1、5、10 min时最大感觉平面差异无统计学意义（P〉0.05）;两组产妇的踝关节运动功能恢复时间及手术持续时间比较,差异均无统计学意义（P〉0.05）。③两组1、5 min新生儿Apgar评分进行比较,差异均无统计学意义（P〉0.05）;观察组产妇无痛比例高于对照组,轻度及中度疼痛比例低于对照组,差异均有统计学意义（P〈0.05）。④观察组产妇未出现寒战（0级）的比例显著高于对照组产妇,发生寒战（1～3级）的比例显著低于对照组产妇,差异均有统计学意义（P〈0.05）。结论小剂量的舒芬太尼联合布比卡因进行蛛网膜下腔注射可以有效地预防剖宫产手术产妇麻醉后的寒战发生率,并降低牵拉痛的出现。

Objective To investigate the clinical application effect of small doses Sufentanil in cesarean section waist hard joint anesthesia. Methods 80 cases of pure line full-term pregnancy cesarean section of delivery in Chongqing Health Centre for Women and Children from March to June 2015 were selected and divided into observation group and control group with 40 cases in each group. All the parturients were treated with combined spinal-epidural anesthesia, parturients in control group were given 0.75% Bupivacaine （2.0 mL） and 5% Glucose （1.0 mL）, parturients inobserva- tion group were given Sufentanil （5 μg, 0.1 mL） on the bases of control group. ①The heart rate, mean arterial pressure before operation, 1, 3, 5, 10 min after medicine and at the end of operation between the two groups were compared. ② The biggest feeling flat after the medicine 1, 5, 10 rain and the ankle movement recovery time, operation duration time between the two groups were compared. ③The Apgar score 1, 5min after the birth of the newborn between the two groups were compared; the occurrence of chill and dragging pain between the .two groups were recorded and compared. Results ①The differences of heart rate, mean arterial pressure before operation, 1, 3, 5, 10min after medicine and at the end of operation between the two groups were not statistically significant （P 〉 0.05）. ②The differences of biggest feeling flat after the medicine 1, 5, 10 rain between the two groups were not statistically significant （P 〉 0.05）; The dif- ferences of the ankle movement recovery time, operation duration time between the two groups were not statistically sig- nificant （P 〉 0.05）. ③The differences of the Apgar score 1, 5 min after the birth of the newborn between the two groups were not statisticaily significant （P 〉 0.05）. The proportion of no pain in observation group was higher than that in control group, the proportion of mild and moderate pain in the differences were statistically significant （P 〈 0.05）. ④The higher than that in control group, the proportion of chill （1-3 observation group were lower than those in control group, proportion of no chili （0 grade） in observation group was grade） in observation group were lower than those in con- trol group, the differences were statistically significant （P 〈 0.05）. Conclusion It can prevent the chill and reduce the occurrence of dragging pain after the anesthesia in cesarean puerpera with small doses Sufentanil combined with Bupi- vacaine in retinal inferior vena injection.