舒芬太尼用于腰硬联合麻醉分娩镇痛对胎心率的影响  

Effect of combined spinal and epidural anesthesia with sufentanil on fetal heart rate

作　　者：徐渐 徐铭军[1,2] Xu Jian;Xu Mingjun(Department of Anesthesiology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100026,China;Department of Anesthesiology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Huairou Maternal and Child Health Center,Beijing 101400,China)

机构地区：[1]首都医科大学附属北京妇产医院,北京妇幼保健院麻醉科,北京100026 [2]首都医科大学附属北京妇产医院怀柔妇幼保健院麻醉科,北京101400

出　　处：《国际麻醉学与复苏杂志》2024年第6期591-596,共6页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨蛛网膜下腔使用舒芬太尼行腰硬联合麻醉(CSEA)分娩镇痛对胎心率的影响及可能机制。方法选择行CSEA分娩镇痛的产妇90例,采用随机数字表法分为舒芬太尼8μg组(S8组)、舒芬太尼5μg组(S5组)和罗哌卡因3 mg组(R3组),每组30例。3组产妇均行CSEA,S8组、S5组、R3组产妇分别予1 mg/L舒芬太尼0.8 ml、1 mg/L舒芬太尼0.5 ml或1%罗哌卡因0.3 ml用脑脊液稀释至1.5 ml后匀速注入蛛网膜下腔。观察记录分娩镇痛前至分娩镇痛后30 min胎心率异常和产妇子宫收缩增强的发生情况;分别记录产妇分娩镇痛前(T_(0)),分娩镇痛后5 min(T_(1))、15 min(T_(2))、30 min(T_(3))的视觉模拟评分法(VAS)疼痛评分及肾上腺素、去甲肾上腺素、缩宫素、前列腺素E2(PGE2)水平;记录产妇低血压、瘙痒等并发症,中转剖宫产的情况,新生儿1 min、5 min、10 min Apgar评分。结果3组产妇分娩镇痛后胎心率异常、低血压、中转剖宫产、子宫收缩增强的发生率差异无统计学意义(均P>0.05)。3组产妇T_(0)、T_(1)、T_(2)、T_(3)时肾上腺素、去甲肾上腺素、缩宫素、PGE2水平及VAS疼痛评分,新生儿1 min、5 min、10 min Apgar评分差异无统计学意义(均P>0.05)。S8组和S5组产妇分娩镇痛后瘙痒发生率高于R3组(均P<0.05);S8组产妇瘙痒发生率高于S5组,但差异无统计学意义(P>0.05)。结论蛛网膜下腔使用舒芬太尼8μg、5μg或罗哌卡因3 mg行CSEA后胎心率异常的发生率差异无统计学意义,镇痛效果满意,可安全用于分娩镇痛。Objective To investigate the effect of combined spinal and epidural anesthesia(CSEA)with sufentanil in the subarachnoid space on fetal heart rate and its possible mechanism.Methods A total of parturients undergoing CSEA for labor analgesia were selected.According to the random number table method,they were divided into three groups(n=30):a sufentanil 8μg group(S8 group),a sufentanil 5μg group(S5 group)and a ropivacaine 3 mg group(R3 group).All the three groups were subject to CSEA.Parturients in the S8 group,the S5 group,and the R3 group were injected with 1 mg/L sufentanil at 0.8 ml,1 mg/L sufentanil at 0.5 ml,or 1% ropivacaine at 0.3 ml diluted with cerebrospinal fluid to 1.5 ml in the subarachnoid space at a constant rate.The abnormal fetal heart rate and uterine contraction were recorded from the beginning of labor analgesia to 30 min after labor analgesia.Their Visual Analogue Scale(VAS)scores and levels of epinephrine,norepinephrine,oxytocin,and prostaglandin E2(PGE2)were recorded before labor analgesia(T_(0)),5 min after labor analgesia(T_(1)),15 min after labor analgesia(T_(2))and 30 min after labor analgesia(T_(3)).The incidences of complications such as hypotension,pruritus,conversion to cesarean section and neonatal 1 min,5 min and 10 min Apgar score were recorded.Results There was no statistical difference in the incidences of abnormal fetal heart rate,hypotension,conversion to cesarean section,enhanced uterine contraction after labor analgesia among the three groups(all P>0.05).There were no statistical differences in the levels of epinephrine,norepinephrine,oxytocin,PGE2,and VAS scores at T_(0),T_(1),T_(2) and T_(3),and neonatal 1 min,5 min and 10 min Apgar score among the three groups(all P>0.05).The incidence of pruritus after labor analgesia in the S8 and S5 groups was significantly higher than that in the R3 group(all P<0.05);the incidence of pruritus in the S8 group was higher than that of the S5 group,without statistical difference(P>0.05).Conclusions There is no statistical difference in th

关 键 词：分娩镇痛 舒芬太尼 胎心率 腰硬联合麻醉 

分 类 号：R714.3[医药卫生—妇产科学]