不同剂量舒芬太尼与罗哌卡因复合硬膜外麻醉在剖宫产术中的应用

Application of different doses of sufentanil and ropivacaine combined with epidural anesthesia in cesarean section

目的探讨不同剂量舒芬太尼与罗哌卡因复合硬膜外麻醉在剖宫产术中的应用。方法选择在我院住院并行剖宫产手术的孕妇90例。随机分为三组,三组患者均采用硬膜外麻醉,A组的麻醉药物采用0.75%罗哌卡因10 m L,B组麻醉药物采用0.75%罗哌卡因10 m L与舒芬太尼10μg,C组麻醉药物采用0.75%罗哌卡因10 m L与舒芬太尼20μg。观察并比较三组产妇的感觉阻滞起效时间、运动阻滞起效时间、镇痛持续时间、下肢运动神经阻滞程度、术中肌松等级、取胎时VAS疼痛评分情况及不良反应,同时观察娩出时新生儿Apgar评分。结果 B组与C组感觉阻滞起效时间、运动阻滞起效时间均快于A组(P<0.05或P<0.01),而C组较B组起效更快(P<0.05);B组与C组镇痛持续时间均长于A组(P<0.05或P<0.01),而B组与C组镇痛持续时间相当(P>0.05);B组与C组取胎时VAS评分均低于A组(P<0.05或P<0.01),而C组较B组VAS评分更低(P<0.05);三组孕妇Bromage评分、术中肌松评分、新生儿娩出1 min、5 min时Apgar评分、术后并发症两两比较无统计学差异(P>0.05)。结论采用0.75%罗哌卡因复合20μg舒芬太尼能取得最好的麻醉效果,产妇感觉与运动阻滞快、镇痛持续时间长、取胎时VAS低,不良反应少。

Objective To investigate the application of different doses of sufentanil and ropivacaine combined with epidural anesthesia in cesarean section. Methods A total of 90 pregnant women who were hospitalized in our hospital and received cesarean section in our hospital were selected. They were randomly divided into three groups, and three groups of patients were all given epidural anesthesia. The anesthetics in group A was 10 mL 0.75% ropivacaine, the anesthetics in group B was 10 mL 0.75% ropivaeaine and 10 p^g sufentanil, and the anesthetics in group C was 10 mL 0.75% ropivacaine and 20 Ixg sufentanil. The onset time of sensory block, the onset time of exercise block, the duration of analgesia, the degree of motor nerve block of lower extremity, the degree of muscle relaxation, the VAS pain scores upon fetus taking and adverse reactions were observed and compared among the three groups, and at the same time, the neonatal Apgar score was observed upon delivery. Results The onset time of sensory block and the onset time of motor block in group B and group C were faster than that in group A（P〈0.05 or P〈O.01 ）, while the onset in group C was faster than that in group B（P〈0.05）; the duration of analgesia in group B and group C was longer than that in group A（P〈 0.05 or P〈O.01）, while the duration of analgesia in group B and group C was similar（P〉0.05）; the VAS scores in group B and group C upon fetus taking were lower than those in group A（P〈O.05 or P〈0.O1）, while the VAS score in group C was lower than that in group B （P〈O.05）. There were no statistically significant differences in the Bromage score, intra- operative muscle relaxation score, neonatal Apgar score at 1 min and 5 rain after delivery and postoperative complications between the three groups. Conclusion 0.75% ropivacaine combined with 20 Ixg sufentanil can achieve the best anesthetic effect. Maternal feeling and motor block are fast, analgesic duration is long, VAS is low upon fetus taking, and adverse reactions are less.