三种辅助硬膜外麻醉方法用于再次剖宫产手术产妇的临床效果

Clinical efficacy of three methods for assisting epidural anesthesia in puerperants undergoing repeat cesarean section

目的比较三种辅助硬膜外麻醉方法用于再次剖宫产手术产妇的临床效果。方法硬膜外麻醉下行再次剖宫产手术的90例产妇随机分为三组,每组30例。三组硬膜外均分次注入0.75%罗哌卡因15mL实施硬膜外阻滞。辅助用药:D组手术开始前10min内静脉注射右美托咪定0.5μg/kg,继以0.4μg·kg^(-1)·h^(-1)的速率静脉泵注;R组手术开始前以0.05μg·kg^(-1)·min^(-1)的速率静脉输注雷米芬太尼;S组硬膜外阻滞同时加入舒芬太尼10μg。D组和R组术中根据产妇VAS疼痛评分及呼吸频率调整药物输注速率。记录三组产妇硬膜外麻醉起效时间、最高阻滞平面、感觉阻滞持续时间和罗哌卡因用量。评估手术开始后30min时产妇的VAS疼痛评分和Ramsay镇静评分。记录新生儿复苏例数、出生后脐静脉血pH值及出生后1-min和5-min Apgar评分。术毕行产妇舒适度评分。观察产妇术中不良反应。结果与D组和R组相比,S组罗哌卡因用量和硬膜外麻醉起效时间减少,感觉阻滞持续时间延长(P<0.05)。R组罗哌卡因用量少于D组(P<0.05)。R组产妇舒适度评分高于D组和S组(P<0.05)。与D组相比,R组和S组产妇VAS疼痛评分降低(P<0.05)。D组产妇心动过缓发生率高于R组和S组(P<0.05),S组低血压和瘙痒发生率高于D组和R组(P<0.05)。结论在再次剖宫产手术产妇中,静脉输注雷米芬太尼辅助硬膜外麻醉可以提高麻醉效果和产妇舒适度,对母婴无不良影响。

Objective To compare the clinical efficacy of three methods for assisting epidural anesthesia in the puerperants undergoing repeat cesarean section.Methods A total of 90 puerperants undergoing repeat cesarean section under epidural anesthesia were randomly divided into three groups with 30 cases each.Epidural block was performed with epidural injection of 0.75%ropivacaine in a total dose of 15 mL.Epidural block in group D was assisted by dexmedetomidine 0.5μg/kg intravenously injected within 10 minute before surgery,which was followed by intravenous infusion of dexmedetomidine at a rate of 0.4μg·kg^(-1)·h^(-1).Epidural block in group R was assisted by intravenous infussion of remifentanil at a rate of 0.05μg·kg^(-1)·min^(-1).Epidural block in group S was assisted by sufentanil 10μg,which was added into 15mL of 0.75%ropivacaine for epidural block.During surgery,the infusion rate in groups of D and R was adjusted based on the VAS pain score and respiratory rate.The onset time of epidural block,the highest block plane,duration of sensory block and consumption of ropivacaine were recorded.The VAS pain score and Ramsay sedation score at 30 minutes of surgery were evaluated.pH value of umbilical vein blood after birth and Apgar scores at 1-minute and 5-minute after birth were recorded.The case number needed neonatal resuscitation after birth was also recorded.The comfort score was evaluated at the end of surgery.The adverse reactions were observed.Results Compared with group D and group R,the consumption of ropivacaine and onset time of epidural anesthesia were significantly reduced,and the duration of sensory block was prolonged in group S(P<0.05).The consumption of ropivacaine in group R was less than that in group D(P<0.05).The comfort score in group R was higher than that in group D and group S(P<0.05).Compared with group D,the VAS pain scores in group R and group S were significantly lower(P<0.05).The incidence of bradycardia in group D was higher than that in group R and group S(P<0.05).The incidences of hypotension and pruritus in group S were higher than those in group D and group R(P<0.05).Conclusion Intravenous infusion of remifentanil for assisting epidural anesthesia can improve the efficacy of epidural anesthesia and maternal comfort without adverse effect on maternity and neonate in the puerperants undergoing repeat cesarean section.