罗哌卡因复合曲马多蛛网膜下隙阻滞用于剖宫产术

目的观察罗哌卡因复合曲马多蛛网膜下隙阻滞用于剖宫产术的麻醉效能。方法90例美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级、择期行剖官产术的产妇。随机均分为3组。采用蛛网膜下隙阻滞联合硬膜外阻滞,R组蛛网膜下隙给予罗哌卡在10mg,RF组予罗哌卡因10 mg 芬太尼20μg,RT组予罗哌卡因10 mg 曲马多20 mg。观察起效时间、感觉阻滞及运动阻滞情况。术后随访完全镇痛时间、有效镇痛时间、术后产妇感觉晟疼痛时的视觉模拟(VAS)评分以及头痛、恶心等并发症。结果3组产妇的感觉阻滞起效时间、最大阻滞平面、达最大阻滞平面时间以及达布(Bromage)Ⅲ级的例数和时间的差异均无显著性(P值均＞0．05)。RF组和RT组完全镇痛时间、有效镇痛时间、术后产妇感觉最疼痛时的VAS评分、术后镇痛药使用比例与R组比较差异均有显著性(P值均＜0．05),而RF组与RT组间的差异无显著性(P值均＞0．05)。结论与复合芬太尼一样,罗哌卡因复合曲马多蛛网膜下隙阻滞用于剖宫产术能达到良好的麻醉效果,延长术后镇痛的时间。     

右美托咪啶混合舒芬太尼用于剖宫产术后病人自控静脉镇痛的效果

目的 评价右美托咪啶混合舒芬太尼用于剖宫产术后病人自控静脉镇痛(PCIA)的效果.方法 择期脊椎-硬膜外麻醉下行剖宫产术病人120例,年龄18～40岁,身高155～170 cm,采用随机数字表法,将病人随机分为3组(n=40):Ⅰ组于胎儿娩出后静脉注射生理盐水20 ml,术后采用舒芬太尼进行PCIA(背景输注速率0.015μg·kg-1·h-1,PCA量0.023 μg/kg,锁定时间8 min);Ⅱ组于胎儿娩出后静脉注射右美托咪啶0.5 μg/kg,术后PCIA同Ⅰ组;Ⅲ组术中处理同Ⅱ组,术后采用舒芬太尼混合右美托咪啶进行PCIA(舒芬太尼背景输注速率0.015 μg·kg-1·h-1,右美托咪啶背景输注速率0.045 μg·kg-1·h-1,舒芬太尼PCA量0.023 μg/kg、右美托咪啶PCA量0.07 μg/kg,锁定时间8 min).于麻醉前和输注右美托咪啶1 h时测定痛阈和耐痛阈,于术后4、8、24 h时记录VAS评分、警觉/镇静评分和舒芬太尼用量,于术后3 h时记录恶露排出量,记录泌乳发动时间,于术后24 h时行病人满意度评价,于麻醉前和输注右美托咪啶1 h、术后24 h时采集外周静脉血样,采用双抗体夹心酶联免疫吸附法测定血清皮质醇浓度,记录不良反应的发生情况.结果 与Ⅰ组比较,Ⅱ组和Ⅲ组输注右美托眯啶1 h时痛阈和耐痛阈升高,Ⅲ组术后4、8、24 h时VAS评分和舒芬太尼用量降低,病人满意度升高(P＜0.05);与Ⅱ组比较,Ⅲ组术后4、8、24 h时VAS评分和舒芬太尼用量降低,Ⅲ组病人满意度升高(P＜0.05);其余指标组间比较差异无统计学意义(P＞0.05).结论 右美托咪啶混合舒芬太尼用于剖宫产术后PCIA的效果优于单独应用舒芬太尼.

Abstract：

Objective To evaluate the efficacy of dexmedetomidine combined with sufentanil for patientcontrolled intravenous analgesia (PCIA) after caeserean section. Methods One hundred and twenty parturients aged 18-40 yr undergoing caeserean section under spinal-epidural anesthesia were randomly assigned to one of 3 groups( n=40 each):group Ⅰ , group Ⅱ and group Ⅲ . During operation as soon as the baby was bom a bolus of dexmedetomidine 0.5 μg/kg was given iv in Ⅱ and Ⅲ groups while in group Ⅰ normal saline (NS) was given instead. Ⅰ and Ⅱ groups received PCIA with sufentanil (background infusion 0.015 μg·kg-1·h-1;bolus dose 0.023 μg/kg;lockout interval 8 min). Group Ⅲ received PCIA with sufentanil + dexmedetomidine (background infusion sufentanil 0.015 μg·kg-1 ·h-1 + dexmedetomidine 0.045 μg·kg· h-1;bolus dose sufentanil 0.023 μg/kg + dexmedetomidine 0.07 μg/kg;lockout interval 8 min) . Pain threshold and pain tolerance threshold were measured before caeserean section and 1 h after bolus dose of dexmedetomidine or NS. VAS, OAA/S and satisfaction scores and sufentanil consumption were recorded at 4, 8 and 24 h after operation.Blood samples were obtained before anesthesia,1 h after bolus injection of dexmedetomidine, and 24 h after operation for determination of serumcortisol concentration. Results Pain threshold and pain tolerance threshold at 1 h after bolus injection of dexmedetomidine were significantly increased as compared with the baseline before anesthesia in Ⅱ and Ⅲ groups and were significantly higher in Ⅱ and Ⅲ groups than in group Ⅰ . VAS scores and the consumption of sufentanil were significantly lower while the satisfactory score was significantly higher in group Ⅲ than in Ⅰ and Ⅱ groups. Serum cortisol concentrations were significantly increased at 1 h after iv dexmedetomidine or NS injection as compared with the baseline before anesthesia in all 3 groups, but there was no significant difference in serum cortisol levels among the 3 groups. Conclusion Addition of dexmedetomidine to sufentanil for PCIA can significantly reduce the consumption of sufentanil and improve parturient's satisfaction.     

麻醉状态下氟马西尼对患者脑电双频指数的影响

目的 评估七氟醚麻醉下氟马西尼对患者麻醉深度及脑电双频指数(BIS)的影响.方法 20例ASA Ⅰ或Ⅱ级患者择期全麻下行妇科腹腔镜手术.当麻醉初期BIS(47±3)时静注氟马西尼0.01 mg/kg,记录给药(氟马西尼)前及给药后2、4、6、8、10、15、20 min 7个时点的SBP、DBP、MAP、HR、SpO_2及BIS值.结果 各时点的SBP、DBP、MAP、HR、SpO_2及BIS值差异均无统计学意义.结论 氟马西尼对七氟醚麻醉下患者的镇静程度无明显拮抗作用.     

0.15%罗哌卡因与0.1%罗哌卡因复合舒芬太尼硬膜外分娩镇痛的比较

目的比较单用0.15%罗哌卡因与0.1%罗哌卡因复合舒芬太尼在硬膜外分娩镇痛的效果和不良反应。方法选择足月单胎初产妇257例,年龄18～40岁,BMI 18～35 kg/m~2,随机分为两组,分别采用0.1%罗哌卡因+舒芬太尼0.5μg/ml(A组,n=129)和0.15%罗哌卡因(B组,n=128)行硬膜外分娩镇痛。观察分娩镇痛前、硬膜外给药20 min后和产程中最大VAS疼痛评分,记录镇痛泵按压次数、补救镇痛次数、镇痛药物用量、改良Bromage评分、满意度、产程时间、分娩方式,新生儿出生后1 min和5 min的Apgar评分,记录镇痛期间皮肤瘙痒、恶心呕吐、尿潴留、产时发热等不良反应发生情况。结果两组在硬膜外给药20 min后和产程中最大VAS评分均明显低于分娩镇痛前(P0.05),但两组差异无统计学意义。两组镇痛泵按压次数、补救镇痛次数、麻醉药物用量、改良Bromage评分、满意度差异无统计学意义。两组产程时间、分娩方式、新生儿出生后1 min和5 min的Apgar评分差异无统计学意义。A组有10例(7.8%)皮肤瘙痒,而B组无一例皮肤瘙痒(P0.05)。两组恶心呕吐、尿潴留、产时发热发生率差异无统计学意义。结论单用0.15%罗哌卡因与0.1%罗哌卡因复合5μg/ml舒芬太尼对初产妇硬膜外分娩镇痛效果相当,但单用罗哌卡因时皮肤瘙痒发生率明显降低。     

丙泊酚镇静下氟马西尼对脑电双频指数的影响

目的 研究丙泊酚镇静时氟马西尼对患者脑电双频指数(BIS)的影响.方法 择期行妇科子宫肌瘤剥出术或全子宫切除术患者40例,ASA Ⅰ或Ⅱ级,随机均分为两组.实施椎管内麻醉,术中采用丙泊酚镇静,维持患者BIS值在65±3.分别在关腹时静注氟马西尼0.01 mg/kg(F组)和生理盐水0.1 ml/kg(C组).观察给药前、给药后2、4、6、8、10、15、20 min时的BIS值.结果 给药后6～20 min F组BIS值显著高于C组(P<0.05).结论 丙泊酚镇静时氟马西尼可提高患者的BIS值,加快患者苏醒.