不同剂量舒芬太尼联合罗哌卡因对剖宫产妇血流动力学及麻醉质量的影响

Impacts of different doses of sufentanil combined with ropivacaine on hemodynamics and quality of anesthesia in patients with cesarean section

目的探讨腰麻时不同剂量舒芬太尼联合罗哌卡因对剖宫产妇血流动力学及麻醉质量的影响。方法选取腰麻下行剖宫产术的产妇280例,随机分为四组,每组70例。麻醉药物为0.75%罗哌卡因1.5 ml(11.25 mg)复合舒芬太尼2.50μg(A组)、5μg(B组)、7.50μg(C组)、10μg(D组)。观察四组在麻醉前、麻醉后15 min、胎儿娩出后和手术结束后的血流动力学指标,评估患者的疼痛效果和牵拉反应,记录各组的不良反应情况和新生儿3 min Apgar评分。结果组间比较,四组患者在不同时间段的平均动脉压(MAP)、心率(HR)及血氧饱和度(Sp O2)变化比较,差异均无统计学意义(F分别=0.23、0.56、0.99、1.40、1.51、2.43、1.53、1.50、1.85、2.58、2.09、1.39,P均>0.05)。组内比较,四组MAP在麻醉后15 min、新生儿娩出后及手术结束时均比麻醉前降低(t分别=4.36、3.21、2.71、5.29、4.02、3.25、4.57、3.64、2.73、5.34、4.76、4.46,P均<0.05)。组内各时间点的HR及Sp O2变化比较,差异无统计学意义(F分别=1.68、2.12、1.04、0.97、2.07、2.22、1.54、0.37,P均>0.05)。四组患者麻醉疼痛评估和牵拉反应情况,B、C、D三组均优于A组(χ2分别=6.45、13.00、13.00、7.39、13.93、16.63,P均<0.05)。D组发生恶心呕吐、寒战、瘙痒等不良反应以及麻黄碱使用方面均高于其他三组(χ2分别=10.77、10.77、4.16、15.04、10.96、9.26、15.30、13.26、9.79、10.16、8.10、4.93,P均<0.05),在发生低血压情况以及新生儿3 min Apgar评分比较,差异均无统计学意义(χ2=2.47、F=0.22,P均>0.05)。结论 0.75%罗哌卡因复合5μg或7.50μg舒芬太尼硬膜外-蛛网膜下隙联合阻滞麻醉,麻醉效果较好,对血流动力学影响较小,且具有较高的安全性。

Objective To investigate the impacts of different doses of sufentanil combined with ropivacaine on hemodynamics and quality of anesthesia in patients with cesarean section. Methods Totally 280 cases of parturients who received caesarean section under lumbar anesthesia were randomized into four groups with 70 cases in each. The group A was given 1.5 ml 0.75% ropivacaine（11.25 mg） combined with 2.50μg sufentanil for anesthetic, while group B was given 5.00μg sufentanil group C was given 7.50μg sufentanil, group D was given 10.00μg sufentanil. Hemodynamic parameters were observed at different points including before anesthesia, 15 minutes after anesthesia, after delivery of fetus and after the operation. Pain effect and traction reaction were evaluated and adverse reactions and neonatal 3 minutes Apgar score were recorded. Results There were no significant differences in MAP, HR and Sp O2 among the four groups at different points（F =0.23,0.56,0.99,1.40,1.51,2.43,1.53,1.50,1.85,2.58,2.09,1.39,P〈0.05）.Compared to before anesthesia, the MAP in each group decreased significantly at 15 minutes after anesthesia, after delivery of fetus and after the operation（t = 4.36,3.21,2.71,5.29,4.02,3.25,4.57,3.64,2.73,5.34,4.76,4.46,P〈0.05）. There were no significant differences in HR and Sp O2 at different point among four group（F=1.68, 2.12, 1.04, 0.97, 2.07, 2.22, 1.54, 0.37,P〈0.05）. Pain assessment and traction reaction of group B, group C and group D were significantly better than those of group A（χ2=6.45,13.00,13.00,7.39,13.93,16.63,P〈0.05）. There were significant differences in adverse reactions of nausea and vomiting, chills, itching and other and ephedrine usage between group D and other three groups（χ2= 10.77,10.77,4.16,15.04,10.96,9.26,15.30,13.26,9.79,10.16,8.10,4.93,P〈0.05）. There were no significant differences in hypotension and neonatal 3 minutes Apgar scores among four groups（χ2= 2.47,F=0.22,P〉0.05）. Conclusion 0.75% ropivacaine combined with 5.00 μg or 7.50 μg sufentanil applying in epidural block anesthesia has the better effect of anesthesia and less influence on hemodynamics and higher safety.