舒芬太尼联合罗哌卡因用于剖宫产术后宫缩痛疗效的临床观察  

Clinical Observation on Effect of Sufentanil Combined with Ropivacaine for Postoperative Contraction Pain after Cesarean Section

作　　者：孙红[1] 杨利利[1] 王前[1] 张敏[1] 王天龙[1] SUN Hong;YANG Lili;WANG Qian;ZHANG Min;WANG Tianlong(Department of Anesthesiology,Xuanwu Hospital of Capital Medical University,Beijing100053,China)

机构地区：[1]首都医科大学宣武医院麻醉科

出　　处：《医学综述》2019年第15期3081-3084,3089,共5页Medical Recapitulate

基　　金：“登峰”人才培养计划(DFL20150802)

摘　　要：目的观察舒芬太尼联合罗哌卡因用于剖宫产术后宫缩痛的疗效。方法选择首都医科大学宣武医院产科择期剖宫产孕妇为研究对象,采用随机数字法分为A组、B组、C组、D组,每组20例,分别采用0.1%罗哌卡因、0.2μg/mL舒芬太尼+0.1%罗哌卡因、0.3μg/mL舒芬太尼+0.1%罗哌卡因、0.4μg/mL舒芬太尼+0.1%罗哌卡因进行剖宫产术后硬膜外自控镇痛。对比分析4组孕妇术后不同时段的视觉模拟评分(VAS评分)、宫缩疼痛、术后切口活动疼痛、硬膜外自控镇痛按压次数以及不良反应发生情况。结果4组产妇术后切口活动痛VAS评分从术后4h至8h增至最大,至术后12h评分降低,且随舒芬太尼浓度增加至0.4μg/mL时,VAS评分明显下降,4组组间、时点间比较差异有统计学意义(P<0.01)。4组产妇术后宫缩痛VAS评分从术后4h至术后8h均逐渐增至最高,术后12h评分降至最低,其中D组各时点VAS评分下降最快,其次为C组,4组间、时点间、组间和时点间交互作用比较差异有统计学意义(P<0.01)。4组产妇硬膜外自控镇痛按压次数比较,差异无统计学意义(P>0.05)。4组产妇术后镇痛12h的改良Bromage评分均为0分。只A组出现1例恶心,未见其他不良事件发生。结论舒芬太尼+罗哌卡因用于剖宫产术后硬膜外镇痛的疗效显著,且0.4μg/mL舒芬太尼+0.1%罗哌卡因的麻醉剂量能显著减轻术后切口痛及宫缩疼痛。Objective T o analyze the clinical effects of sufentanil combined with ropivacaine on contraction pain after cesarean section Methods Patients who underwent elective cesarean operation in XuanWu Hospital of Capital Medical University were randomly separated into four groups(n=20):group A(0.1%ropivacaine),group B(0.2μg/mL sufentanil+0.1%ropivacaine),group C(0.3μg/mL sufentanil+0.1%ropivacaine),group D(0.4μg/mL sufentanil+0.1%ropivacaine),for patient-controlled epidural analgesia(PCEA)after cesarean section.The visual analogue scale(VAS),uterine contraction pain,wound movement pain,the number of times of patient-controlled epidural analgesia pressing and the occurrence of adverse reactions were compared and analyzed in the four groups.Results From 4 hours to 12 hours after operation,VAS score of movement pain in the four groups increased gradually to the maximum,and decreased to 12 hours after operation,when the concentration of sufentanil increased to 0.4μg/mL,the VAS score significantly decreased,and the differences between the four groups and time points were statistically significant(P<0.01).The VAS score of contraction pain in the four groups increased gradually to the maximum from 4 hours to 8 hours,and decreased to 12 hours after operation,and group D VAS score decreased fastest,followed by group C,and the differences between the four groups,time points,and the group·time interaction(P<0.01).The total number of PCEA was not significantly different between the four groups(P>0.05).The scores of improved Bromage score in the four groups were all 0 at 12 hour after operation.Only one case of nausea occurred in group A,and no other adverse events occurred.Conclusion Sufentanil combined with ropivacaine can be used safely and effectively in patients after cesarean section,and the analgesic effect of 0.4μg/mL sufentanil+0.1%ropivacaine is best,which can significantly reduce the contraction pain and movement pain after cesarean section.

关 键 词：剖宫产 硬膜外自控镇痛 舒芬太尼 罗哌卡因 

分 类 号：R719.8[医药卫生—妇产科学]