不同方式注入等剂量舒芬太尼致产妇瘙痒的比较

Comparison about Maternity Pruritus Induced by Sufentanil Injected by Different Ways

目的比较不同方式注入等剂量舒芬太尼致产妇瘙痒的差别。方法足月妊娠产妇180例,采用随机数字表法,将其分为6组(n=30)静脉组(Ⅵ组)、硬脊膜外腔组(Ⅲ组和Ⅴ组)、蛛网膜下腔组(Ⅰ组、Ⅱ组和Ⅳ组)。腰硬联合麻醉,所有注入液均用0.9%生理盐水稀释至2mL,用2.5mL注射器以0.2mL/s的速度推注。记录自舒芬太尼注射完毕至2h内(T__(0-2))及在3h(T_3)、6h(T_6)、12h(T_(12))、24h(T_(24))时各发生瘙痒的例数、瘙痒的起始时间(T_s)、瘙痒的部位、产妇自述瘙痒明显减轻的时间(T_e)、瘙痒评分、新生儿出生5min时Apgar评分。结果蛛网膜下腔组比静脉组和硬脊膜外腔组瘙痒例数明显增多(P<0.05);Ⅰ组和Ⅱ组产妇瘙痒的起始时间(T_s)明显快于Ⅳ组(P<0.05);在T_3、T_6时,Ⅰ组和Ⅱ组产妇发生瘙痒的例数明显多于Ⅳ组(P<0.05);与T_(0-2)时发生瘙痒例数比较,Ⅰ组和Ⅱ组在T_6、T_(12)、T_(24)时明显减少(P<0.05),而Ⅳ组中,T_3、T_6、T_(12)、T_(24)时均明显减少(P<0.05);在瘙痒评分中Ⅰ组和Ⅱ组与Ⅳ组比较,产妇发生瘙痒的例数在0级时减少、2级时增多(P<0.05)。结论从蛛网膜下腔注入等剂量的舒芬太尼比从静脉和硬脊膜外腔注入更容易引发产妇瘙痒;罗哌卡因可以明显降低舒芬太尼致瘙痒发生的状况;痒神经与脊神经在体表分布是不一致的。

Objective T_o compare the disparity of maternity pruritus induced by sufentanil injected by different ways. Methods 180 puerpera were randomly divided into 6 groups(n=30 each): vein group(group Ⅵ), epidural group(groups Ⅲ and Ⅴ), spinal group(groups Ⅰ and Ⅱ and Ⅳ). Combined spinal-epidural anesthesia, all injection was diluted to 2 mL with 0.9% saline and pushed at a rate of 0.2 mL/s. T_hese numbers of pruritμs were recorded at 2 h(T_0-2), at 3 h(T_3), at 6 h(T_6), at 12 h(T_(12)), at 24 h(T_(24)) after sufentanil injection, the starting time, parts and ease time of pruritus and pruritus scores and Apgar scores at 5 min after birth were also recorded. Results T_he number of pruritus in group spinal was much more than that in groups vein and epidural(P <0.05), pruritus starting time was faster in groups Ⅰand Ⅱ than that in group Ⅳ(P<0.05); Compared with group Ⅳ, the number of pruritus were significantly increased in groups Ⅰand Ⅱ at T_3 and T_6(P <0.05); Compared with T_(0-2), the number of pruritus in groups Ⅰ and Ⅱ were significantly decreased at T_6 and T_(12) and T_(24), while that in group Ⅳ were significantly decreased at T_3 and T_6 and T_(12) and T_(24)(P <0.05); Compared with group Ⅳ in pruritus scores, the numbers in groups Ⅰ and Ⅱ were significantly decreased at 0 score and increased at 2 score(P<0.05). Conclusion Injecting the isodose sufentanil, spinal was much easier to make maternity itching than vein and epidural; Ropivacaine could significantly decrease pruritus conditions; Itch nerve distribution in body surface was not consistent with spinal nerve.