罗哌卡因联合舒芬太尼腰硬联合麻醉用于剖宫产手术的效果

Effect of Ropivacaine with Sufentanil Combined Spinal-epidural Anesthesia for Cesarean Section

目的观察罗哌卡因复合不同剂量的舒芬太尼腰硬联合麻醉用于剖宫产手术的效果。方法选取2019年1月1日~11月1日天津市第二医院拟行择期剖宫产手术的产妇120例作为研究对象,按随机数字表法分成A组、B组和C组,每组40例。三组在手术前腰硬联合麻醉时均注入罗哌卡因与舒芬太尼混合液,注射速度分别为A组1 ml/10 s、B组1 ml/15 s、C组1 ml/20 s,测平面达到手术需要后,比较三组麻醉前(T_(0))、麻醉后1 min(T_(1))、5 min(T_(2))、15 min(T_(3))各时刻平均动脉压、心率,记录三组最高感觉阻滞平面例数、循环支持药物使用次数、恶心呕吐、需要硬膜外药物干预例数、新生儿Apgar评分。结果A组麻醉后T_(1)、T_(2)、T_(3)平均动脉压和心率低于T_(0)时刻,且B组、C组,差异有统计学意义(P<0.05);而B组、C组各时刻平均动脉压和心率比较,差异无统计学意义(P>0.05)。A组恶心呕吐次数、循环支持药物使用次数高于B组、C组,差异有统计学意义(P<0.05);B组需要硬膜外药物干预例数低于A组、C组,差异有统计学意义(P<0.05);而A组最高感觉阻滞平面例数比例高于B组、C组,差异有统计学意义(P<0.05)。三组产妇新生儿出生后1、3、5 min时Apgar评分比较,差异无统计学意义(P>0.05)。结论罗哌卡因复合不同剂量的舒芬太尼腰硬联合麻醉用于剖宫产手术,蛛网膜下腔注药速度1 ml/15 s时能够更好满足手术需求,同时循环系统稳定,不良反应少,需要硬膜外额外给药干预的少,母婴更安全。

Objective To observe the effect of ropivacaine combined with different doses of sufentanil combined spinal-epidural anesthesia for cesarean section.Methods From January 1st to November 1st,2019,120 cases of parturients who planned to undergo elective cesarean section in Tianjin Second Hospital were selected as the research objects,and were divided into groups A,B and C according to the random number table method,each group 40 cases.The three groups were injected with a mixture of ropivacaine and sufentanil during combined spinal-epidural anesthesia before surgery.The injection speeds were 1 ml/10 s for group A,1 ml/15 s for group B,and 1 ml/20 s for group C.After the measurement plane reached the operation requirement,compare the three groups of average arterial pressure and heart rate at each time before anesthesia(T_(0)),1 min(T_(1)),5 min(T_(2)),and 15 min(T_(3))after anesthesia,and record the number of cases with the highest sensory block level,the number of times of circulatory support drugs used,and nausea and vomiting,the number of cases requiring epidural intervention,and the Apgar score of newborns.Results T_(1),T_(2),T_(3)mean arterial pressure and heart rate after anesthesia in group A were lower than T_(0),the difference between group B and group C was statistically significant(P<0.05);There was no statistically significant difference in the average arterial pressure and heart rate between group B and group C at each time(P>0.05).The number of nausea and vomiting and the use of circulatory support drugs in group A were higher than those in group B and C,the difference was statistically significant(P<0.05);The number of cases requiring epidural intervention in group B was lower than that in groups A and C,the difference was statistically significant(P<0.05);The highest sensory block level in group A was higher than that in group B and C,the difference was statistically significant(P<0.05).There was no statistically significant difference in Apgar scores at 1,3,and 5 min after birth among the three groups of newborns(P>0.05).Conclusion Ropivacaine combined with different doses of sufentanil combined spinal-epidural anesthesia for cesarean section,the subarachnoid injection speed of 1 ml/15 s can better meet the needs of surgery.At the same time,the circulatory system is stable,the adverse reactions are few,and the extradural intervention is less,and the mother and baby are safer.