罗哌卡因复合小剂量舒芬太尼蛛网膜下腔注射应用于择期剖宫产术的临床研究

目的观察罗哌卡因复合小剂量舒芬太尼蛛网膜下腔注射应用于择期剖宫产术的麻醉效果，探索两药联合应用的合理配伍剂量。方法将择期120例腰硬联合麻醉下剖宫产孕妇随机分成四组，Ⅰ组：1．5ml 0．75％罗哌卡因＋1 ml 10％葡萄糖＋0．5ml舒芬太尼5μg；Ⅱ组：1．5ml 0．75％罗哌卡因＋1ml 10％葡萄糖＋0．5ml舒芬太尼7．5μg；Ⅲ组：1．5ml 0．75％罗哌卡因＋1ml 10％葡萄糖＋0．5ml舒芬太尼10．0μg；Ⅳ组：2．0ml 0．75％罗哌卡因＋1ml 10％葡萄糖，每组30例。比较各组产妇椎管内阻滞的效果、术中牵拉反应的抑制程度、围术期并发症的发生率及新生儿脐带血气、Apgar评分的统计学差异。结果Ⅱ、Ⅲ、Ⅳ组较Ⅰ组术中硬膜外追加局麻药量减少（X^2=10．23，P均〈0．05）；Ⅳ组的寒战和低血压的发生率低（X^2分别=12．38、14．20，P均〈0．05）；Ⅰ、Ⅱ组与Ⅲ组比较．围术期瘙痒的发生率降低（X^2=13．45，P均〈0．05）。Ⅰ、Ⅱ组与Ⅲ、Ⅳ纽相比恶心、呕吐的发生率偏低（X^2分别=9．87、10．05，P均〈O．05）。新生儿娩出后的Apgar评分（胎儿娩出即刻、娩出后10min）、从切皮至娩出时间及新生儿脐带血气分析结果（pH、PCO2、PO2、SBE）的比较均无明显统计学差异（X^2分别=2．05、2．19、3．32、2．49、1．96、2．97、1．78，P均〉0．05）。各组感觉麻醉平面、产妇呼吸抑制、术后头痛发生率及Bromage评分〉3的发生率也同样无统计学差异（X^2分别=2．59、3．42、2．45、1．87，P均〈0．05）。结论罗哌卡因复合舒芬太尼蛛网膜下腔注射麻醉效果确切。可安全应用于剖宫产术。舒芬太尼7．5μg（H组）复合11．25mg罗哌卡因蛛网膜下腔注射行择期剖宫产术的围术期并发症相对较少，该配伍相对更合理。

Effects of intrathecal hyperbaric ropivacaine combined with sufentanil on parturients undergoing elective cesarean section

Objective To evaluate the efficacy and safety of minor doses sufentanil added to hyperbaric ropivaeaine intrathecally in nulliparous undergoing elective cesarean section under combined spinal-epidural anesthesia. Methods 120 term parturients in spontaneous labor were randomly assigned to receive one of the following hyperbaric opioid-local anesthetic mixtures （Ⅰ ：1.5ml 0.75%ropivacaine＋lml 10%GS＋0.5ml sufentanil 5μg; Ⅱ： 1.5ml 0.75%ropivacaine＋1ml 10%GS＋0.5ml sufentanil 7.5μg; Ⅱ： 1.5ml 0.75%ropivacaine＋1ml 10%GS＋ 0.5ml sufentanil 10.0μg; Ⅳ：2.0ml 0.75%ropivacaine＋1ml 10%GS）. Characteristics of spinal block, intraoperative quality of spinal anesthesia, side-effects, additional local anesthetics and fetal outcomes were evaluated. Results Group Ⅱ, Ⅲ and Ⅳ require less additional local anesthetics than group I （X^2=10.23, P 〈0.05）. Group IV had high percentage of chill and hypotension （X^2=12.38,14.20, P 〈0.05）. Group Ⅰ and Ⅱhad less pruritus, nausea and vomiting when compared with group Ⅲ and Ⅳ （X^2=13.45,9.87,10.05, P 〈0.05）. Compared with group Ⅲ and Ⅳ, group I and group II had less nausea and vomiting （X^2=9.87,10.05, P〈0.05）. Apgar scores （instant and 10 min later）, the time from incision to the birth of the neonate and the Umbilical cord blood gases （pH,PCO2,PO2,SBE）did not differ statistically （X^2=2.05,2.19,3.32,2.49,1.96,2.97,1.78, P 〉0.05）. Sensor level, respiratory depress, postoperative headache and Bromage scale （Bromage〉3） had no significant differences among groups （X^2= 2.59,3.42,2.45,1.87, P〈0.05）. Conclusion The intrathecal mixture of hyperbaric ropivacaine combined with sufentanil remains an acceptable choice when performing cesarean sections under combined spinal-epidural anesthesia. Moreover, 1.5ml 0.75% ropivacaine ＋ lml 10% GS ＋ 0.5ml sufentanil （7.5μg）,which has less perioperative complications, indicates more advantages over other groups.