阿芬太尼复合罗哌卡因用于宫颈环扎术的有效性及安全性

Efficacy and safety of alfentanil combined with ropivacaine for cervical cerclage

目的探讨阿芬太尼复合罗哌卡因用于宫颈环扎术的有效性及安全性。方法选取2023年1月至12月在西部战区总医院行宫颈环扎术的100例孕妇作为研究对象,随机分为罗哌卡因组和阿芬太尼+罗哌卡因组,每组50例。经L2-L3或L3-L4间隙实施硬膜外穿刺,罗哌卡因组注入0.75%盐酸罗哌卡因注射液10 ml,阿芬太尼+罗哌卡因组注入0.75%盐酸罗哌卡因注射液7 ml、盐酸阿芬太尼注射液10μg/kg。记录两组患者麻醉前和宫颈环扎时心率(HR)和平均动脉压(MAP),比较两组患者麻醉阻滞平面、感觉阻滞起效时间、运动阻滞持续时间、痛觉恢复时间、不良反应发生率、术后尿潴留发生率、术后孕周延长时间及患者和医生满意度评分等指标。结果两组患者在麻醉平面低于胸10例数、感觉阻滞起效时间、运动阻滞持续时间、术后孕周延长时间、术后尿潴留发生率及患者和医生满意度评分等指标的差异均无统计学意义(P>0.05)。与麻醉前相比,两组患者宫颈环扎时HR和MAP均明显下降。与罗哌卡因组比较,阿芬太尼+罗哌卡因组宫颈环扎时HR[(69.79±4.87)次/min vs.(75.42±4.23)次/min]和MAP[(72.96±6.21)mmHg vs.(80.55±4.49)mmHg]更低,痛觉恢复时间更长[(5.49±1.37)h vs.(4.51±1.09)h],不良反应发生率更低(2%vs.16%),差异均有统计学意义(P<0.05)。结论阿芬太尼复合罗哌卡因用于宫颈环扎术,能有效维持血流动力学稳定,减少不良反应发生率,镇痛效果肯定,安全性高。

Objective To investigate the efficacy and safety of alfentanil combined with ropivacaine for cervical cerclage.Methods A total of 100 patients undergoing cervical cerclage from January 2023 to December 2023 were randomly divided into two groups:ropivacaine group and alfentani+ropivacaine group,with 50 cases in each group.Epidural puncture was performed through the L2-L3 or L3-L4 interval.The ropivacaine group was injected with 10 ml of 0.75%ropivacaine hydrochloride injection,and the alfentanil+ropivacaine group was injected with 7 ml of 0.75%ropivacaine hydrochloride injection+10μg/kg of alfentanil hydrochloride injection.The heart rate(HR)and mean arterial pressure(MAP)were recorded before anesthesia and during cervical cerclage in the two groups,and the anesthesia block plane,onset time of sensory block,duration of motor block,recovery time of pain sensation,incidence of adverse reactions,incidence of postoperative urinary retention,extension of postoperative gestational age and satisfaction scores of patients and doctors were compared between the two groups.Results There were no significant differences in the case number with anesthesia plane under chest 10,onset time of sensory block,duration of motor block,extension of postoperative gestational age,incidence of postoperative urinary retention,or the satisfaction scores of patients and doctors between the two groups(P>0.05).HR and MAP decreased significantly in both groups at cervical cerclage compared with before anesthesia.Compared with the ropivacaine group,the alfentanil+ropivacaine group had even lower HR[(69.79±4.87)bpm vs.(75.42±4.23)bpm]and MAP[(72.96±6.21)mmHg vs.(80.55±4.49)mmHg],longer pain recovery time[(5.49±1.37)h vs.(4.51±1.09)h]and lower adverse reaction rate during cervical cerclage(2%vs.16%).The difference was statistically significant(P<0.05).Conclusion Alfentanil combined with ropivacaine for cervical cerclage can effectively maintain hemodynamic stability and reduce adverse reactions,and it has definite analgesic effect and high safety.