小剂量等比重布比卡因复合舒芬太尼腰硬联合麻醉在剖宫产术中的应用价值观察

Observation of the application value of low dose isobaric bupivacaine combined with sufentanil in spinal-epidural anesthesia in cesarean section

目的 探讨剖宫产术应用小剂量等比重布比卡因复合舒芬太尼腰硬联合麻醉的可行性及安全性。方法选取2014年7月~2016年2月在我院行剖宫产术的108例产妇为研究对象,经随机数字表法分为观察组54例,对照组54例,对照组给予小剂量等比重布比卡因,观察组在对照组基础上复合应用舒芬太尼。观察两组产妇麻醉效果、生命体征变化及不良反应发生情况。结果 观察组运动、感觉阻滞起效时间明显较对照组短,最高感觉平面时间及有效镇痛时间明显较对照组长,差异有统计学意义（P〈0.05）;两组产妇麻醉前、麻醉后1 min生命体征无明显差异（P〉0.05）,麻醉后5、15、30 min,观察组心率及平均动脉压与对照组比较差异有统计学意义（P〈0.05）,观察组波动明显更小;观察组产妇恶心、呕吐、低血压、呼吸抑制、皮肤瘙痒等不良反应发生率为25.93%,同对照组的14.81%比较,差异无统计学意义（P〉0.05）,两组均未出现严重不良反应。结论 剖宫产腰硬联合麻醉中,选择小剂量等比重布比卡因复合舒芬太尼可获得满意麻醉效果,产妇生命体征稳定,不良反应少,安全性高,值得推广。

Objective To investigate the feasibility and safety of low dose isobaric bupivacaine combined with sufentanil in spinal-epidural anesthesia in Cesarean section. Methods 108 puerpera who were given Cesarean section in our hospital from July 2014 to February 2016 were selected as the study subjects. The patients were divided into the observation group（54 cases） and the control group（54 cases） according to the random number table. The control group was given low-dose isobaric bupivacaine. The observation group was combined with sufentanil on the basis of the control group. The anesthetic effect, changes of vital signs and adverse reactions were observed in the two groups of puerpera.Results The onset time of motor block and sensory block in the observation group was significantly shorter than that in the control group. The maximal sensory plane time and effective analgesia time were significantly longer than those in the control group, and the difference was statistically significant（P〈0.05）; there was no significant difference in vital signs between the two groups before anesthesia and 1 min after anesthesia（P〉0.05）. At 5, 15 and 30 minutes after anesthesia, the heart rate and mean arterial pressure in the observation group were statistically significantly different from those in the control group（P〈0.05）, and the fluctuation in the observation group was significantly smaller. The incidence rate of adverse reactions such as nausea, vomiting, hypotension, respiratory depression and pruritus in the observation group was 25.93%, which was not significantly different from that of 14.81% in the control group（P〉0.05）. There were no severe adverse reactions in both groups. Conclusion In the combined spinal-epidural anesthesia in Cesarean section, satisfactory results can be obtained by selecting low dose isobaric bupivacaine combined with sufentanil, with stable maternal vital signs, less adverse reactions, and high safety, which is worthy of promotion.