阿芬太尼对腰-硬联合麻醉剖宫产术中牵拉痛及寒战的影响

Effects of alfentanil on traction pain and shivering during combined spina-epidural anesthesial for cesarean section

目的观察阿芬太尼对腰硬联合麻醉下行剖宫产术的产妇术中牵拉痛和寒战的防治效果,为临床提供参考。方法选择铜陵市人民医院2022年1-12月在腰硬联合麻醉下行剖宫产的产妇共62例,采用随机数字表分为阿芬太尼组(A组)和对照组(C组),每组各31例。2组产妇均进行腰硬联合麻醉,麻醉后调整麻醉感觉平面至T 6~8,A组胎儿娩出夹闭脐带后,静脉注射阿芬太尼3.0μg/kg,随后持续静脉泵入阿芬太尼0.125μg/(kg·min)至术毕,C组胎儿娩出夹闭脐带后给予等剂量生理盐水至术毕。记录2组产妇一般情况,术中牵拉痛发生情况,寒战、恶心、呕吐、皮肤瘙痒及低氧血症的发生率,各时间点产妇的平均动脉压(MAP)、心率(HR)。结果2组产妇一般情况比较差异无统计学意义(均P>0.05),2组牵拉痛发生率[22.58%(7/31)vs.56.67%(17/30)]差异有统计学意义(P<0.05),A组无中重度牵拉痛,且A组寒战(6.5%,2/31)的发生率明显低于C组(33.3%,10/30,χ^(2)=6.972,P<0.05)。2组产妇皮肤瘙痒和恶心、呕吐的发生率比较差异无统计学意义(均P>0.05)。2组产妇组间各时间点MAP、HR差异无统计学意义(MAP:F组间=0.142,P=0.708;HR:F组间=0.006,P=0.937),组内不同时间点差异有统计学意义(MAP:F时间=24.434,P<0.001;HR:F时间=11.045,P<0.001),组别与时间不存在交互作用(MAP:F交互=1.107,P=0.355;HR:F交互=0.616,P=0.659)。结论阿芬太尼可有效预防腰硬联合麻醉剖宫产产妇牵拉反应及寒战的发生。

Objective To investigate the effect of alfentanil on the prevention of traction pain and shivering in puerperae during combined spina/epidural anesthesia(CSEA)cesarean section,to provide a reference for clinical work.Methods A total of 62 parturients who underwent cesarean section under combined spinal-epidural anesthesia at Tongling People's Hospital from January to December 2022 were selected and randomly divided into two groups using a random number table:alfentanil group(group A)and control group(group C),31 cases per group.After anesthesia,the level of anesthesia sensation was adjusted to T 6-8.After delivery of the umbilical cord,alfentanil 3μg/kg was injected intravenously,then continuous intravenous infusion alfentanil at 0.125μg/(kg·min);Group C puerperae were given the same dose of normal saline after delivery of the umbilical cord clamping until the end of the operation.We recorded the general situation,intraoperative traction pain,shivering,skin itching,nausea,vomiting and meionectic blood rates in the groups,mean arterial pressure(MAP)and heart rate(HR)of puerperaeat at each time point.Results There was no significant difference in general condition between the two groups of parturients(P>0.05),There was a significant difference in the incidence of traction pain between the two groups[22.58%(7/31)vs.56.67%(17/30),P<0.05].Group A had no moderate to severe traction pain,and the incidence of tremor in Group A(6.5%,2/31)was significantly lower than that in Group C(33.3%,10/30,χ^(2)=6.972,P<0.05).There was no significant difference in the incidence of pruritus,nausea,and vomiting between the two groups of parturients(P>0.05).There was no significant difference in MAP and HR at different time points between the two groups of parturients(MAP:F interblock=0.142,P=0.708;HR:F interblock=0.006,P=0.937),there was a statistically significant difference at different time points within the group(MAP:F time=24.434,P<0.001;HR:F time=11.045,P<0.001),and there was no interaction between the group and time(MAP:F interaction=1.107,P=0.355;HR:F interaction=0.616,P=0.659).Conclusion Alfentanil can effectively prevent traction reaction and shivering in cesarean section under CSEA.