剖宫产术患者重比重罗哌卡因混合小剂量舒芬太尼腰麻的效果  

Intrathecal small-dose sufentanil enhances hyperbaric spinal ropivacaine for caesarean section

作　　者：邬子林[1] 韩光炜[2] 余守章[1] 

机构地区：[1]广州医学院附属广州市第一人民医院麻醉科,510180 [2]上海交通大学附属市第一人民医院麻醉科

出　　处：《中华麻醉学杂志》2007年第10期910-913,共4页Chinese Journal of Anesthesiology

基　　金：广州市医药卫生科研基金资助项目（2003-YB-023）

摘　　要：目的探讨重比重罗哌卡因混合小剂量舒芬太尼用于剖宫产术患者腰麻的效果。方法择期行剖宫产术的单胎和妊娠足月初产妇40例,年龄22～34岁,体重60～73 kg,ASAⅠ级。随机分为2组（n=20）,罗哌卡因组（R组）蛛网膜下腔注射1%罗哌卡因1.5 ml（15 nag）＋生理盐水0.7ml＋ 50%葡萄糖0.3 ml;罗哌卡因＋舒芬太尼组（R＋S组）蛛网膜下腔注射1%罗哌卡因1.5 ml（15 mg）＋舒芬太尼5μg（0.1 ml）＋生理盐水0.6 ml＋50%葡萄糖0.3ml。蛛网膜下腔穿刺成功后,将混合药液注入蛛网膜下腔,速率0.1 ml/s。记录感觉阻滞、运动阻滞情况,术中疼痛程度、腹肌松弛程度和牵拉反应程度,术中低血压、心动过缓、恶心、呕吐及瘙痒等不良反应的发生和处理情况,新生儿体重及出生后1 min和5 min Apgar评分。结果R＋S组蛛网膜下腔注药后感觉阻滞平面达到T10、T6和最高阻滞平面的时间短于R组,且最高阻滞平面升高（P〈0.05或0.01）;蛛网膜下腔注药后2组下肢运动阻滞起效时间和达最大运动阻滞时间差异无统计学意义,2组最大运动阻滞评分均为3分（P〉0.05）。R＋S组感觉阻滞恢复至L3、首次感觉疼痛和开始PCA镇痛的时间比R组长（P〈0.05或0.01）,下肢运动阻滞完全恢复时间组间比较差异无统计学意义（P〉0.05）。R＋S组牵拉反应程度低于R组（P〈0.01）。2组不良反应发生率、麻黄碱和阿托品使用率及新生儿体重、出生后1min和5 min Apgar评分差异无统计学意义（P〉0.05）。结论剖宫产术患者重比重罗哌卡因混合舒芬太尼5μg腰麻感觉阻滞起效时间缩短,阻滞平面上移,持续镇痛作用时间延长。　Objective To investigate the efficacy of small-dose sufentanil added to hyperbaric spinal ropivacaine for caesarean section.Methods Forty ASAⅠnulliparous women aged 22-34 yr weighing 60-73 kg with a singleton full-term pregnancy scheduled for caesarean section under spinal anesthesia were randomly allocated to one of 2 groups（n=20 each）in a double-blind manner：group A received 1% ropivacaine 1.5 ml＋normal saline（NS）0.7 ml＋50% glucose 0.3 ml（2.5 ml in total）and group B received 1% ropivacaine 1.5 ml＋ NS 0.6 ml＋50% glucose 0.3 ml＋sufentanil 5μg in 0.1 ml（2.5 ml in total）.The spinal anesthesia was performed at L_（2,3）interspace.The onset time of sensory block,time to peak sensory and motor block,duration of analgesia and motor block and quality of spinal anesthesia during operation were recorded.Hemodynamics,side- effects and fetal outcome were also recorded.Results There was no significant difference in demographic data and operation time between the two groups.The onset of sensory block and time to maximum sensory block were significantly shorter in group B than in group A.The upper level of sensory block was significantly higher and duration of analgesia longer in group B than in group A.There was no significant difference in onset of motor block,time to maximum motor block and recovery of motor block between the 2 groups.There was also no significant difference in the incidence of hypotension and other side-effects and Apgar scores of the newborn between the two groups.Conclusion The addition of sufentanil 5μg to hyperbaric spinal repivacaine shortens the onset time of sensory block,increases the height of sensory block and prolongs the duration of analgesia.

关 键 词：酰胺类 舒芬太尼 麻醉 脊椎 剖宫产术 

分 类 号：R686[医药卫生—骨科学]