舒芬太尼复合不同浓度罗哌卡因腰硬联合麻醉应用于急诊剖宫产术的效果比较  

Effect Comparison of Combined Spinal and Epidural Anesthesia with Sufentanil and Different Concentrations of Ropivacaine for Emergency Cesarean Section

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作  者:王娟 曾祥刚 吴仲 张洋 WANG Juan;ZENG Xianggang;WU Zhong;ZHANG Yang(Department of Anesthesiology,Guiyang Maternal and Child Health Hospital,Guiyang 550003,China;Department of Anesthesiology,Affiliated Hospital of Guizhou Medical University,Guiyang 550001,China;Department of Anesthesiology,the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang 550001,China)

机构地区:[1]贵阳市妇幼保健院麻醉科,贵阳550003 [2]贵州医科大学附属医院麻醉科,贵阳550001 [3]贵州中医药大学第一附属医院麻醉科,贵阳550001

出  处:《医学综述》2023年第11期2262-2267,共6页Medical Recapitulate

基  金:贵州省中医药管理局中医药、民族医药科学技术研究课题(QZYY-2019-009)。

摘  要:目的比较舒芬太尼复合不同浓度罗哌卡因腰硬联合麻醉应用于急诊剖宫产术的效果。方法选择2020年1月至2021年2月在贵阳市妇幼保健院行急诊剖宫产术分娩的孕产妇95例作为研究对象,均采取舒芬太尼复合罗哌卡因腰硬联合麻醉,根据罗哌卡因浓度不同分为0.75%罗哌卡因组(0.75%罗哌卡因2 ml,47例)、0.50%罗哌卡因组(0.50%罗哌卡因2 ml,48例)。比较两组麻醉效果(运动阻滞和感觉阻滞的起效时间、持续时间)、应激反应情况(血清皮质醇、去甲肾上腺素、超氧化物歧化酶、丙二醛水平)、术后恢复能力(情绪状态、身体舒适度、心理支持、自理能力、疼痛评分和总分)及不良反应发生率。结果两组产妇运动阻滞和感觉阻滞的起效时间、持续时间比较差异均无统计学意义(P>0.05)。术后24 h,0.50%罗哌卡因组血清皮质醇、去甲肾上腺素、超氧化物歧化酶、丙二醛水平均低于0.75%罗哌卡因组(P<0.01);术后3 d,0.50%罗哌卡因组血清皮质醇、去甲肾上腺素、超氧化物歧化酶、丙二醛水平均低于0.75%罗哌卡因组[(202±16)μg/L比(214±19)μg/L、(234±1)μg/L比(261±2)μg/L、(39.78±2.47)kU/L比(41.15±2.53)kU/L、(6.58±1.64)nmol/L比(7.42±1.83)nmol/L](P<0.05或P<0.01)。术后1周,0.50%罗哌卡因组产妇情绪状态、身体舒适度、心理支持、自理能力和疼痛评分及总分均高于0.75%罗哌卡因组(P<0.01)。0.50%罗哌卡因组总不良反应发生率低于0.75%罗哌卡因组[8.33%(4/48)比25.53%(12/47)](χ^(2)=3.863,P=0.049)。结论舒芬太尼复合0.50%罗哌卡因腰硬联合麻醉即可达到剖宫产麻醉效果要求,且相较0.75%罗哌卡因应激反应小、不良反应少,更有助于孕妇术后恢复,安全性好。Objective To compare the effect of combined spinal and epidural anesthesia with sufentanil and different concentrations of ropivacaine for emergency cesarean section.Methods A total of 95 pregnant women who underwent cesarean section delivery under combined spinal and epidural anesthesia with sufentanil and ropivacaine in Guiyang Maternal and Child Health Hospital from Jan.2020 to Feb.2021 were included.According to the concentration of ropivacaine used,they were divided into a 0.75%ropivacaine group(0.75%ropivacaine,2 ml,47 cases)and a 0.50%ropivacaine group(0.50%ropivacaine,2 ml,48 cases).The anesthesia effect(the onset time and duration of motor block and sensory block),stress response(the levels of serum cortisol,norepinephrine,superoxide dismutase and malondialdehyde),postoperative recovery ability(maternal emotional state,physical comfort,psychological support,self-care ability,pain score and total score)and incidence of adverse reactions were compared between the two groups.Results There was no significant difference in the onset time and duration of motor block and sensory block between the two groups(P>0.05).The levels of serum cortisol,norepinephrine,superoxide dismutase and malondialdehyde in the 0.50%ropivacaine group were lower than those in the 0.75%ropivacaine group 24 h after surgery(P<0.01).Three days after surgery,the levels of serum cortisol,norepinephrine,superoxide dismutase and malondialdehyde in the 0.50%ropivacaine group were lower than those in the 0.75%ropivacaine group[(202±16)μg/L vs(214±19)μg/L,(234±1)μg/L vs(261±2)μg/L,(39.78±2.47)kU/L vs(41.15±2.53)kU/L,(6.58±1.64)nmol/L vs(7.42±1.83)nmol/L](P<0.05 or P<0.01).One week after surgery,maternal emotional state,physical comfort,psychological support,self-care ability,pain score and total score in the 0.50%ropivacaine group were higher than those in the 0.75%ropivacaine group(P<0.01).The incidence of total adverse reactions in the 0.50%ropivacaine group was lower than that in the 0.75%ropivacaine group[8.33%(4/48)vs 25.53%(12/

关 键 词:剖宫产 舒芬太尼 罗哌卡因 腰硬联合麻醉 麻醉效果 

分 类 号:R719.8[医药卫生—妇产科学]

 

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