0．125％左布比卡因配伍不同浓度舒芬太尼用于剖宫产术后PECA的效果观察

Effects of 0.12 5 % Levobupivacaine with Different Concentrations of Sufentanil on Patient-Controlled Epidural Analgesia （PCEA） After Cesarean Section

【目的】比较0．125％左布比卡因配伍不同浓度舒芬太尼用于剖宫产术后病人自控硬膜外镇痛（PECA）的临床效果，探讨舒芬太尼的适宜浓度。【方法】选取择期行剖宫产的足月单胎产妇120例，年龄23～34岁，体质量58-80kg，ASA分级工或Ⅱ级；按照随机数字表法分为3组，每组各40例。Ⅰ组、Ⅱ组、Ⅲ组分别采用0．4、0．6、0．8μg／mL舒芬太尼配伍0．125％左布比卡因；术后均行PECA维持48h，负荷剂量5mL，持续输注剂量2mL，单次给药剂量2mL，锁定时间15min。采用视觉模拟评分法（VAs）评价术后48h内疼痛程度，以VAS≥4分记为PECA失败；采用改良Bromage评分法评价下肢运动阻滞程度。分别于麻醉前（T0）、术后24h（T1）、48h（T2）测定血清泌乳素水平，记录初乳时间。记录PECA总按压次数，观察术后24h内恶心、呕吐、嗜睡、瘙痒、低血压、呼吸抑制、心动过缓及尿潴留等不良反应发生情况。【结果】Ⅱ组、Ⅲ组的总按压次数、PECA失败率、初乳时间明显低于Ⅰ组，术后24h和48h血清泌乳素水平明显高于Ⅰ组，差异具有统计学意义（P〈0．05）；Ⅱ组和Ⅲ组在总按压次数、PECA失败率、初乳时间及术后24h和48h血清泌乳素水平方面比较差异无统计学意义（P〉0．05）；三组的改良Bromage评分比较差异无统计学意义（P〉0．05）；Ⅲ组术后不良反应发生率明显高于Ⅰ组、Ⅱ组，差异具有统计学意义（P〈0．05）；工组、Ⅱ组的不良反应发生率比较差异无统计学意义（P〉0．05）。【结论】0．6μg／mL是舒芬太尼配伍0．125％左布比卡因用于剖宫产术后PECA的适宜浓度。

[Objective]To observe the clinical effects of 0.125% Levobupivacaine with different concentrations of sufentanil on patient-controlled epidural analgesia （PCEA） after cesarean section, and to determine the suitable concentration of sufentanil for this process. [Methods]One hundred twenty （ n = 120） cases of fullterm, single-fetal women who elected for cesarean section in our hospital were selected as the study subjects. The women aged 23 - 34 years old, weighed 58 - 80 kg, and had ASA class of Ⅰ or Ⅱ. According to a random number table, the 120 women were evenly divided into 3 groups （ n =40 cases）. Groups Ⅰ , Ⅱ , and Ⅲ , respectively, were given 0.4, 0.6, and 0.8 μg/mL of s ufentanil combined with 0.125% Levobupivacaine. The loading dose was 5 mL, continuous infusion dose was 2 ml, the single drug dose was 2 ml, and the locking time was 15 min. The Visual Analogue Scale （VAS） was used to evaluate the patients＇ degree of pain 48 h postoperative. If the VAS score was ≥4, then the PCEA was deemed as a failure. A modified Bromage scoring system was used to evaluated the lower limb movement. Serum prolactin levels before anesthesia （T0）, 24 h after surgery （T1）, and 48 h after surgery （T2） were recorded along with the times of colostrum. The total number of PCEA uses, postoperative nausea, vomiting, lethargy, itching, low blood pressure, respiratory depression, bradycardia, urinary retention, and other adverse reactions were observed.[Results]The number of PCEA total uses, PCEA failure rate, and times of colostrum in groups Ⅱ and Ⅲ were lower than those in group Ⅰ . The serum prolactin levels of group Ⅱ and Ⅲ 24 h and 48 h after surgery were significantly higher than those of group Ⅰ , with a statistically significant difference （ P 〈0.05）. The number of PCEA uses, PCEA failure rate, times of colostrum, and the serum prolactin levels 24 h and 48 h after surgery were not significantly different between groups Ⅱ and Ⅲ（ P 〉0.05）. The modified Bromage scores and their changes in the three groups had no statistically significant differences （ P 〉0.05）. The incidence of postoperative adverse reaction of group Ⅲ was significantly higher than that of groups Ⅰ and Ⅱ the difference was statistically significant （ P 〈0.05）. The incidence of adverse reactions in groups Ⅰ and Ⅱ , however, had no statistically significant difference （ P 〉0.05）. [Conclusion]It is determined that 0.6 ug/ml is the suitable concentration of sufentanil to use in conjunction with 0.125% levobupivacaine for PCEA after cesarean section.