舒芬太尼对剖宫产罗哌卡因蛛网膜下腔阻滞效应的影响

目的剖宫产术中，与单纯罗哌卡因对照，比较5μg舒芬太尼复合罗哌卡因蛛网膜下腔阻滞的麻醉效果及对新生儿的影响。方法入选产妇80例完全随机分为4组，每组20例，R组给予1％罗哌卡因15mg；SR1、SR2、SR3组给予1％罗哌卡因15、13、10mg复合5μg舒芬太尼L3。间隙行腰硬联合阻滞麻醉，患者术后行硬膜外镇痛。观察指标包括胎心率、运动阻滞和感觉阻滞情况、麻醉效果分级、新生儿娩出后1、5minApgar评分、血气指标及不良反应。结果sR3组麻醉效果分级低于R、SR1、SR2组。SR1、SR2、SR3组达最高阻滞平面时间较R组均缩短；恢复至T12时间，R≈SR3〈SR2≈SR1；首次感觉疼痛和镇痛泵开启时间，R〈SR3≈SR2≈SR1；Bromage评分为3发生情况，SR3〈R=SR2=SR1；恢复至Bromage评分为0的时间，SR3〈SR2〈R≈SR1。SR1、SR2、SR3各组蛛网膜下腔给药后5minFHR明显变慢、瘙痒的发生率增高、但寒战发生率减低。结论13mg罗哌卡因复合5μg舒芬太尼蛛网膜下腔阻滞可以安全地用于剖宫产手术，增强麻醉效果。

Effects of Sufentanil on the Ropivacaine spinal block in Caesarean Section

Objective Cesarean section, with ropivacaine alone for the control group, compared anesthetic effects and the fetal impact of sufentanil combined with 5 μg ropivacaine in subarachnoid block. Methods Eighty cases of patients underwent cesarean section were enrolled (ASA Ⅰ～Ⅱ) and randomly divided into 4groups(n= 20):1% ropivacaine 15 nag (R group), 1% ropivacaine 15 mg combined with 5 μg sufentanil (SR1 Group), 1% ropivacaine 13 mg combined with 5 μg sufentanil (SR2 Group), 1% ropivacalne 10 mg combined with 5 μg sufen-tanil(SR3 group). All patients were administrated the mixture after the success with L3-4 spinal puncture and moni-tored the FHR; intraoperative monitoring of respiratory and circulatory situation continued. Visual analogue score (VAS) as Ice touch was used to determine the effect of sensory block and modified Bromage was used to assess mo-tor block. The effect of intracperative anesthesia, epidural anesthetic drug dosage and adverse reactions were recor-ded. 1 and 5 minute fetal heart rate (FHR) after administration , neonatal 1,5 minute Apgar score, umbilical arte-rial pH and BE values after delivery were recorded also. Results There were no significant differences among four groups of patients in terms of age, height, weight and surgery time (P>0.05). The anesthetic effect of SR3 group was lower than that of R, SR1, SR2 group (P<0.01). The IV anesthetic effect score showed SR3 was shortened. T12 recovery time showed R≈SR30.05) regarding the 1-minute FHR changes after subarachnoid administration a-mong R group and SR1、SR2、SR3 group. Apgar scores, pH value, BE value at each time point after birth showed no significant difference among 4 groups (P>0.05). Conclusions 5 μg Sufentanil in combination with ropivacaine subarachnoidly can be safely applied for cesarean section. It shortens sensory block onset time, blocks higher planes and prolongs continuous analgesia.