罗哌卡因复合舒芬太尼在瘢痕子宫剖宫产术麻醉的临床效果多方面分析

Anesthesia effect of ropivacaine combined with sufentanil in cesarean section of scar uterus was analyzed in many aspects

目的比较小剂量盐酸罗哌卡因复合舒芬太尼和单纯盐酸罗哌卡因在腰硬联合麻醉下瘢痕子宫剖宫产手术中的临床应用效果。方法选取2018年1月至2018年6月来本院行择期剖宫产术的40例瘢痕子宫孕妇作为研究对象,随机分为两组。选择L2~3或L3~4间隙蛛网膜下腔穿刺成功后,分别注入0.75%罗哌卡因7.5 mg+舒芬太尼5μg(观察组,n=20)和0.75%罗哌卡因13 mg(对照组,n=20)。观察两组产妇腰麻给药前后血压变化情况,记录运动恢复时间、痛觉恢复时间;牵拉反应、肌肉松弛程度、麻醉效果;观察新生儿出生后1 min、5 min Apgar评分及术中不良反应的发生情况。结果观察组术中血压波动小,循环稳定,低血压发生率明显低于对照组,观察组麻黄碱使用率小于对照组,两组比较差异有统计学意义(P<0.05),观察组运动恢复时间小于对照组,痛觉恢复时间明显大于对照组,两组比较差异有统计学意义(P<0.05),两组产妇牵拉反应、肌肉松弛程度、麻醉效果、度异用药情况比较差异有统计学意义(P<0.05)。两组新生儿Apgar评分比较差异无统计学意义。两组产妇不良反应比较差异有统计学意义(P<0.05)。结论 0.75%罗哌卡因7.5 mg+舒芬太尼5μg腰麻用于二次剖宫产手术对产妇血流动力学影响小,下肢运动恢复早,术后镇痛时间长,麻醉效果确切,且不良反应少,能提高剖宫产手术的安全性和产妇的舒适性。

Objective To compare the clinical application effect of low-dose ropivacaine combined with sufentanil and ropivacaine alone in caesarean section with scar under CSEA anesthesia. Methods 40 pregnant women with scar uterus who underwent elective cesarean section from January 2018 to June 2018 were selected as the research objects, and they were randomly divided into two groups. After successful subarachnoid space in L2-3 or L3-4 Spaces, 0.75% ropivacaine 7.5 mg + sufentanil 5 μg(20 cases in the observation group) and 0.75% ropivacaine 13 mg(20 cases in the control group) were respectively injected. Ropivacaine 13 mg(20 cases in the control group). The changes of blood pressure before and after the administration of lumbar anesthesia in the two groups were observed and recorded as well as the recovery time of exercise and pain perception, traction response, muscle relaxation anesthesia effect. The Apgar scores and the adverse reactions during the operation were recorded 1 min and 5 min after birth. Results Observation group of parturient women blood pressure fluctuations in the small, cycle stability, low blood pressure significantly lower than the control group, the incidence of observation group of ephedrine utilization is less than the control group, two groups compare the difference was statistically significant(P<0.05), the observation group of movement recovery time is less than the control group, pain recovery time significantly greater than the control group, two groups compare the difference was statistically significant(P<0.05), two groups of maternal pull effect of reaction, the degree of muscle relaxation, anesthesia degree of different medications, Pethidine Hydrochloride and Promethazine utilization have statistical significance(P<0.05), two groups of neonatal Apgar score no statistical significance, there were statistically significant differences in adverse reaction between the two group(P<0.05). Conclusion 0.75% ropivacaine 7.5 mg + sufentanil 5 μg lumbar anesthesia used in the second cesarean section operation has little effect on maternal hemodynamics, early recovery of lower limb movement, long postoperative analgesia, accurate anesthesia effect, and less adverse reactions can improve the safety of cesarean section operation and maternal comfort.