苏芬太尼联合罗哌卡因蛛网膜下腔阻滞对妊娠期高血压疾病剖宫产术麻醉效果、母婴结局及安全性的影响

Analysis of influence of anesthetic effect, maternal and infant outcomes and safety of subarachnoid block using sulfentanyl combined with ropivacaine for patients with gestational hypertension in the cesarean section

目的 研究妊娠期高血压疾病患者剖宫产术中采用苏芬太尼联合罗哌卡因蛛网膜下腔阻滞对麻醉效果、母婴结局及安全性的影响.方法 选取180例拟行剖宫产术的妊娠期高血压疾病患者为研究对象,将其按数字表法随机分为A组、B组、C组,各60例.A组10 mg盐酸罗哌卡因、B组13 mg盐酸罗哌卡因、C组10 mg盐酸罗哌卡因联合5μg枸橼酸苏芬太尼麻醉.观察三组患者的麻醉效果、循环功能、镇痛持续时间、手术时间、新生儿出生后Apgar评分、新生儿体质量、术毕运动阻滞情况、不良反应及并发症.结果 B组与C组之间麻醉效果差异均无统计学意义（χ2=1.233、1.465,均P＞0.05）,B组及C组的麻醉效果均优于A组（χ2 =4.293、1.394,均P＜0.05）.A组和C组对比各时间点HR、MAP值差异均无统计学意义（F=1.313、1.265,均P＞0.05）,与T0比较,B组T1、T2、T3、T4时HR、MAP与A组、C组差异均有统计学意义（F=5.633、7.299,均P＜0.05）.三组手术时间差异无统计学意义（F=0.933,P＞0.05）;B组与C组疼痛持续时间差异无统计学意义（t=0.822,P＞0.05）,A组的疼痛持续时间均比B组与C组长,差异有统计学意义（F=8.316,P＜0.05）;三组新生儿出生后1 min、5 min的Apgar评分和新生儿出生体质量差异均无统计学意义（F =0.822、0.929,均P＞0.05）,A组与C组间改良Bromage评分差异均无统计学意义（t=2.627、1.991,均P＞0.05）,B组与A组和C组改良Bromage评分差异均有统计学意义（F=6.371、5.693,均P＜0.05）.B组的运动神经完全恢复时间明显长于A组和C组（F=8.924,P＜0.05）,A组、B组的呕吐、恶心概率明显高于C组（F=3.561、12.581,均P＜0.05）,B组心动过缓及低血压发生率均明显高于A组、C组（F=8.273、10.833,均P＜0.05）.B组阿托品、麻黄碱的用量和使用概率明显高于A组、C组（F=8.316、10.291,均P＜0.05）.结论 蛛网膜下腔阻滞麻醉时采用5μg苏芬太尼加入10 mg盐酸罗哌卡因可应用于轻、中度妊娠期高血压疾病剖宫产术中麻醉,其不良反应轻,镇痛效果好,对血流动力学影响小,值得临床推广.

Objective To study the influence of anesthetic effect,maternal and infant outcomes and safety of subarachnoid block used sulfentanyl combined with ropivacaine for patients with gestational hypertension in the cesarean section.Methods 180 cases of gestational hypertension ready to cesarean section were selected as study subjects,and they were randomly divided into A group,B group and C group by digital table method,60 cases in each group.A group used 10mg ropivacaine,B group used 13mg ropivacaine,C group used 5μg sulfentanyl combined with 10mg ropivacaine.The anesthetic effect,circulation function,duration of pain,operation time,neonatal Apgar score at 1 and 5 min after birth,neonatal weight,motor block evaluation after operation,adverse reaction and complication were compared in three groups.Results The anesthetic effect between B group and C group had no statistical difference （χ2 =1.233,1.465,all P 〉 0.05）.The anesthetic effect of B group and C group was better than that of A group（F =5.633,7.299,all P 〈0.05）.The HR and MAP of every time points between A group and C group had no statisticaldifferences （F =1.313,1.265,all P 〉 0.05）.Compared with T0,the HR and MAP of B group at T1,T2,T3,T4 had statistical differences compared with A group and C group（F =5.633,7.299,all P 〈0.05）.The operation time of the three groups had no statistical difference（F =0.933,P 〉 0.05）.The duration of pain between B group and C group had no statistical difference（t =0.822,P 〉 0.05）.The duration of pain of A group was longer than that of B group and C group（F =8.316,P 〈0.05）.The neonatal Apgar scores at 1 and 5 min after birth and neonatal weight of the three group had no statistical differences（F =0.822,0.929,all P 〉 0.05）.The improved Bromage score between A group and C group had no statistical difference （t =2.627,1.991,all P 〉 0.05）.The improved Bromage score between B group and A,C group had statistical differences（F =6.371,5.693,all P 〈 0.05）.The complete recovery time of motor nerve of B group was much longer than that of A group and C group （F =8.924,P 〈 0.05）.The incidence rates of vomit and nausea of A group and B group were much higher than that of C group（F =3.561,12.581,all P 〈 0.05）.The incidence rate of bradycardia and hypotension of B group was much higher than that of A group and C group （F =8.273,10.833,all P 〈 0.05）.Conclusion During subarachnoid block anaethesia using 5 μg sulfentanyl combined with l0mg ropivacaine can be applied to mild and moderate gestational hypertension,it has advantages such as less adverse reaction,good analgesic effect,less hemodynamic effect,and it is worthy of clinical promotion.