硬膜外舒芬太尼联合罗哌卡因麻醉对减轻瘢痕子宫产妇择期剖宫产术内脏疼痛的影响研究  

Effect of epidural sufentanil combined with ropivacaine on relieving visceral pain of women with cicatricial uterus during elective caesarean section

作　　者：温蔡英 洪晓玲 温玉英 Wen Caiying;Hong Xiaoling;Wen Yuying(Department of Anesthesiology,Puning Maternal and Child Health and Family Planning Service Center,Jieyang 515300,China;Operating Room of Puning Maternal and Child Health and Family Planning Service Center,Jieyang 515300,China)

机构地区：[1]普宁市妇幼保健计划生育服务中心麻醉科,广东揭阳515300 [2]普宁市妇幼保健计划生育服务中心手术室,广东揭阳515300

出　　处：《实用妇科内分泌电子杂志》2022年第26期29-33,共5页Electronic Journal of Practical Gynecological Endocrinology

基　　金：揭阳市科技计划项目(编号ylxm043)。

摘　　要：目的分析硬膜外舒芬太尼联合罗哌卡因麻醉对瘢痕子宫剖宫产术中内脏疼痛的影响。方法选取100例瘢痕子宫剖宫产产妇,按照随机数字表法分为对照组和研究组,每组50例。对照组应用罗哌卡因麻醉,研究组在对照组用药基础上复合舒芬太尼麻醉。比较两组疼痛感觉消失平面(起效时间)、阻滞完善时间、从麻醉诱导至胎儿娩出时间;应用视觉模拟评分法(VAS)评估两组术中初次注射(T_(0))、麻醉阻滞完善(T_(1))、手术开始后5 min(T_(2))、手术开始后15 min(T_(3))、手术开始后30 min(T_(4))、手术结束后5 min(T_(5))及手术结束后15 min(T_(6))时的内脏疼痛程度;采用改良Bromage评分评估两组术后下肢运动阻滞程度、下肢运动阻滞持续时间、新生儿娩出后的Apgar评分。结果研究组感觉起效时间(12.25±3.23)min、阻滞完善时间(12.56±2.23)min、从麻醉诱导至胎儿娩出时间(23.56±3.65)min均短于对照组的(14.26±3.12)、(22.15±2.84)、(27.23±3.84)min,差异有统计学意义(P<0.05)。两组T_(0)时VAS评分比较差异无统计学意义(P>0.05),两组T_(1~6)时VAS评分明显低于T_(0)时,差异有统计学意义(P<0.05)。研究组术中T_(1)、T_(2)、T_(4)、T_(5)及T_(6)时VAS评分均低于对照组,差异有统计学意义(P<0.05);两组术中T_(3)时VAS评分比较差异无统计学意义(P>0.05)。研究组术后改良Bromage评分低于对照组,下肢运动神经阻滞持续时间短于对照组,差异有统计学意义(P<0.05)。两组新生儿娩出后1、5 min时的Apgar评分比较差异无统计学意义(P>0.05)。结论与单独采用罗哌卡因麻醉相比,联合舒芬太尼可进一步增强剖宫产术中对内脏疼痛的缓解效果,复合麻醉阻滞方式可加快麻醉阻滞药物起效时间,并缩短患者术后下肢运动神经阻滞时间,且未对新生儿产生呼吸抑制作用。Objective To analyze the effects of epidural sufentanil combined with ropivacaine anesthesia on visceral pain during caesarean section with cicatricial uterus.Methods 100 cases of parturients with cicatrical caesarean section were selected as research objects and divided into control group and study group with 50 cases in each group according to the time digital table method.The control group was anesthetized with ropivacaine,and the study group was anesthetized with sufentanil on the basis of the control group.The plane of pain disappearance(time of onset),time of block completion and time from anesthesia induction to fetal delivery were compared between the two groups.Visual analog scale(VAS)was used to evaluate the initial injection(T_(0)),completion of anesthesia block(T_(1)),5 min after the operation(T_(2)),15 min after the operation(T_(3)),30 min after the operation(T_(4)),5 min after the operation(T_(5)),and 15 min after the operation The degree of visceral pain at min(T_(6));the modified Bromage score was used to evaluate the degree of postoperative lower limb motor block,the duration of lower limb motor block and the Apgar score after delivery of the newborn in the two groups.Result The sensory onset time(12.25±3.23)min,block completion time(12.56±2.23)min and time from anesthesia induction to fetal delivery(23.56±3.65)min in the study group were all shorter than those in the control group(14.26±3.12)min,(22.15±2.84)min and(27.23±3.84)min,the difference was statistically significant(P<0.05).There was no significant difference in VAS score between the two groups at T_(0)(P>0.05),and VAS score between the two groups at T_(1-6) was significantly lower than that at T0(P<0.05).The VAS scores at T_(1),T_(2),T_(4),T_(5) and T6 in the study group were lower than those in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in T3 VAS scores between the two groups(P>0.05).The modifi ed Bromage score of the study group was lower than that of the contro

关 键 词：硬膜外 择期剖宫产 舒芬太尼 罗哌卡因 瘢痕子宫 内脏疼痛 

分 类 号：R614[医药卫生—麻醉学]