左布比卡因复合不同浓度舒芬太尼用于剖宫产术后患者硬膜外自控镇痛对母儿的影响  

Effects of Patient-Controlled Epidural Analgesia with Levobupivacaine Plus Different Concentrations of Sufentanil on Mother and Newborn After Caesarean Section

作　　者：李娜[1] 冷福建[1] 余凌[1] 余锦芬[1] 程静[1] 乐呈进[1] 

机构地区：[1]湖北省妇幼保健院麻醉科,湖北武汉430070

出　　处：《武汉大学学报（医学版）》2014年第3期469-473,共5页Medical Journal of Wuhan University

摘　　要：目的:探讨左布比卡因复合不同浓度舒芬太尼用于剖宫产术后病人硬膜外自控镇痛(PCEA)的效果及对母儿的影响。方法:择期行剖宫产手术的足月、单胎产妇90例,年龄22-35岁,体重60-85kg,视觉模拟评分(VAS评分)法分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为3组(n=30):0.125%左布比卡因复合0.4、0.6和0.8μg/ml舒芬太尼组(Ⅰ组-Ⅲ组)。术后分别行PCEA 48h,负荷剂量5ml,持续输注剂量2ml/h,单次给药剂量2ml,锁定时间15min。采用ASA评价术后4,8,12,24,48h的疼痛程度,记录宫缩痛评分,采用改良Bromage评分法评价下肢运动阻滞程度变化,采用放射免疫分析法测定血清泌乳素浓度,进行新生儿神经和适应能力评分(NACS),记录初乳时间及不良反应的发生情况。结果:与Ⅰ组比较,Ⅱ组和Ⅲ组各时点切口痛VAS评分及宫缩痛评分降低、初乳时间提前、术后24、48h时血清泌乳素浓度升高,Ⅲ组恶心呕吐及心动过缓等不良反应的发生率升高(P<0.05);与Ⅱ组比较,Ⅲ组各时点切口痛VAS评分及宫缩痛评分、初乳时间、术后24和48h时血清泌乳素浓度差异无统计学意义(P>0.05),恶心呕吐及心动过缓等不良反应发生率升高(P<0.05);3组改良Bromage评分、新生儿NACS评分比较差异无统计学意义(P>0.05)。结论:0.125%左布比卡因复合舒芬太尼0.6μg/ml用于剖宫产术后患者PCEA镇痛效果好,对母儿不良反应少。Objective： To evaluate the efficacy of patient-controlled epidural analgesia （PCEA） with 0. 125% levobupivacaine plus different concentrations of sufentanil on mother and newborn after caesarean section. Methods： Ninety ASA Ⅰ or Ⅱ full-term nulliparous patients aged 22-35 years weighing 60-85 kg undergoing elective caesarean section under combined spinal epidural anesthe- sia were randomly divided into three groups （n=30 each）： 0. 125 % levobupivacaine plus sufen- tanil 0.4, 0.6, or 0.8 μg/ml groups （groups Ⅰ , Ⅱ and Ⅲ）. The patients received for 48 h of PCEA after operation. PCEA pump was set up with a background infusion of 2 ml/h, and a bolus dose of 2 ml with a lockout-interval of 15 rain after a loading dose of 5 ml. VAS was used to as- sess intensity of pain （0=no pain, 10=worst pain）. VAS score 43 was considered as effective analgesia. The degree of motor block of lower limbs was assessed and scored using modified Bro- mage scale. Venous blood samples were taken before operation and at 24 and 48 h after operation to detect the serum prolactin （PRL） concentration using radioimmunoassay. Uterine contraction pain scores, maternal colostrum time and adverse effects including nausea and vomiting, pruritus and bradycardia were recorded after operation. Results： Compared with that respectively in group Ⅰ , the incision VAS scores and uterine contraction pain scores were significantly decreased, the maternal colostrum time was shortened, and the serum PRL concentration at 24 and 48 h after operation were significantly increased in groups Ⅱ and Ⅲ （P〈0.05）. Compared with that re- spectively in group Ⅱ , no significant change was found in the incision VAS scores and uterine contraction pain scores, maternal colostrum time and the serum PRL concentration at 24 and 48 h after operation （P〉0.05）. Compared with group Ⅰ and Ⅱ , the incidence of adverse effects such as nausea, vomiting and bradycardia were increased in group Ⅲ （P〈0.05）. There was no s

关 键 词：剖宫产术 镇痛 硬膜外 泌乳素 婴儿 新生 神经病理学检查 

分 类 号：R452[医药卫生—治疗学]