低剂量罗哌卡因混合苏芬太尼用于重度子痫前期腰麻下剖宫产术的效果分析

Effect of lose doses ropivacaine and sufentanil in spinal anesthesia of women with severe preeclampsia for casarean delivey

目的 探讨低剂量罗哌卡因混合苏芬太尼用于重度子痫前期腰麻下剖宫产术的效果.方法择期拟在腰麻下行剖宫产术的重度子痫前期产妇40例,年龄20~30岁.采用随机数字表法分为两组,每组20例.常规剂量罗哌卡因组（A组）采用1%罗哌卡因15 mg（1.5 mL）＋10%葡萄糖注射液1 mL＋0.9%氯化钠注射液0.5 mL行腰麻;低剂量罗哌卡因组（B组）采用1%罗哌卡因10 mg（1 mL）＋苏芬太尼1 mL（5 μg）＋10%葡萄糖注射液1 mL行腰麻,蛛网膜下腔给药后10 min每间隔2 min记录一次BP、HR和SpO2,每间隔2.5 min评估感觉和运动阻滞情况,记录术中低血压、恶心、呕吐等不良反应发生情况.结果 B组下肢运动神经阻滞起效时间长于A组[（4.8±2.1）min比（4.2±1.5）min,t=-2.83,P〈0.01],B组下肢运动神经阻滞总时间明显短于A组[（75.9±25.2）min比（115.4±29.5）min,t=10.75,P〈0.01].A组下肢运动神经阻滞达到3级的产妇明显多于B组（χ2=14.54,P〈0.01）.B组术后完全镇痛时间[（180.0±35.0）min比（120.0±27.0）min,t=15.48,P〈0.001）]和有效镇痛时间[（245.0±29.0）min比（184±34）min,t=16.21,P〈0.001）]明显长于A组.B组意识评分为3分产妇明显多于A组（χ2=8.53,P〈0.01）.与A组比较,B组低血压（45.0%比20.0%,χ2=4.29,P〈0.05）、呕吐（30.0%比5.0%,χ2=4.33,P〈0.05）和寒战（50.0%比10.0%,χ2=7.62,P〈0.01）发生率降低,瘙痒发生率升高（χ2=10.16,P〈0.01）.结论 低剂量罗哌卡因（10 mg）混合5 μg苏芬太尼腰麻能完全满足重度子痫前期剖宫产手术的需要,其术中低血压、恶心和寒颤发生率明显降低且其完全镇痛时间和有效镇痛时间明显延长.

Objective To evaluate whether low-dose ropivacaine in combination with sufentanil could produce effective spinal anaesthesia for severe preeclamptic parturients during cesarean section.Methods 40 severe preeclampsia parturients undergoing elective caesarean delivery under combined spinal-epidural anaesthesia were randomly divided into two groups based on a computer-generated grouping number sheet,each group in 20 cases.Group A received intrathecal ropivacaine 15mg （1.5mL）＋10% dextrose 1mL with normal saline 0.5mL.Group B received intrathecal ropivacaine 10mg （1mL） ＋ sufentanil 5μg（1mL） ＋ 10% dextrose 1mL.Blood pressure,heart rate and oxygen saturation were documented at 2 min intervals for 10 min after local anaesthetic was administered.Sensory and motor block were assessed at 2.5 min intervals after spinal injection.The side effects such as hypotension,nausea and vomiting during surgery were recorded.Results The onset of motor block was longer[（4.8±2.1） min vs.（4.2±1.5） min,t=-2.83,P〈0.01],and the duration was shorter[（75.9±25.2） min vs.（115.4±29.5）min,t=10.75,P〈0.01] in group B than those in group A.The number of patients who had Bromage score 3 in group A was more than that in group B.Compared with group A,the duration of complete analgesia[（180±35） min vs.（120±27） min,t=15.48,P〈0.001]and effective analgesia[（245±29）min vs.（184±34）min;t=16.21,P〈0.001] increased in group B.More patients were sleepy but easily rousable in group B than in group A （9cases vs.0cases,χ2=8.53,P〈0.01）.The incidence rate of hypotension was significantly higher（45.0% vs.20.0%,χ2=4.29,P〈0.05） in group A than that in group B.Compared with group A,the incidence rate of hypotension（45.0% vs.20.0%,χ2=4.29,P〈0.05）,vomiting（30.0% vs.5.0%,χ2=4.33,P〈0.05） and shivering （50.0% vs.10.0%,χ2=7.62,P〈0.01） were lower in group B.The incidence of pruritus was significantly higher in group B （χ2=10.16,P〈0.01）.Conclusion Hyperbaric ropivacaine 10 mg with sufentanil 5μg could produce effective spinal anaesthesia for severe preeclamptic parturients during cesarean section with less hypotension,vomiting and shivering,and longer lasting analgesia than hyperbaric ropivacaine 15 mg.