局麻药复合小剂量芬太尼硬膜外麻醉在剖宫产术中的应用

目的观察剖宫产术硬膜外麻醉局麻药中加入小剂量芬太尼对麻醉效果的影响。方法218例ASAI～II级足月单胎头位妊娠产妇硬膜外麻醉下行剖宫产术，随机分为A组（观察组）109例和B组（对照组）109例。选择L2～a行硬膜外穿刺，试验量2％利多卡因4ml，5min无脊麻征象后，A组分次追加含2“g／ml芬太尼的2％利多卡因及0．75％罗哌卡因各5ml，B组则分次追加2％利多卡因及0．75％罗哌卡因各5ml，根据阻滞平面可再追加相应局麻药，直至元痛平面达T8后开始手术。记录阻滞平面达T8所需时间、初次剂量、最高阻滞平面及局麻药作用持续时间;于切皮、进腹、取胎及缝皮时记录VAS评分，监测并记录麻醉前、注药后5min、15min、30min、术毕时SBP、DBP、HR、Sp02i观察进腹及取胎时的牵拉反应以及新生儿出生后1min、5minApgar评分。结果A组在切皮和进腹时VAS评分明显低于B组（P〈0．05），而取胎和缝皮时两组差异无统计学意义（P〉0．05）；最高阻滞平面两组相当，而阻滞平面达Ts所需时间和初次剂量A组明显少于B组（P〈0．05）；麻醉作用持续时间A组明显比B组长（P〈0．01），牵拉反应A组明显轻于B组（P〈0．05），而BP、HR、SpO2及新生儿Apgar评分两组间差异无统计学意义（P〉0．05）。结论局麻药复合小剂量芬太尼硬膜外麻醉可以明显缩短麻醉起效时间，减少局麻药用量，增强麻醉效果，且对新生儿无明显影响，可以安全地用于产科麻醉。

Application of a small dose of Fentanyl adding into epidurai anesthesia in cesarean section

Abstract ：Objective To observe the anesthetic effect of epidural anesthesia adding a small dose of Fentanyl in cesare- an section. Methods 218 cases of ASA I - II class full-term pregnancy,maternal fetal head position single with epidural anesthesia for cesarean section were randomly divided into group A（study group 109 cases） and group B （control group 109 patients）. L2-3 accepted epidural puncture, amount of 2 % Lidocaine 4ml, 5min after no signs of spinal anesthesia, A component containing 2 vg/ml additional 2 % Lidocaine and Fentanyl and Ropivacaine 0.75% 5 ml seeondly,B group graded an additional 2% Lidocaine and 0.75% Ropivacaine each 5ml, according to the corre- sponding block level,local anesthetic could be added until the plane reached T8 after painless surgery. To record the time required for block level of T8, the initial dose, the maximum block level and duration of action of local anesthet- ics;At skin incision,into the abdomen, to take birth and sewing the skin to record the VAS score, monitor and record before anesthesia, after injection 5 rain, 15 min, 30 min, surgery time SBP, DBP, HR, SpO2 ;observe and take into the abdomen during fetal and neonatal responses after birth traction 1 min,5 min Apgar score. Results A group in the skin incision and into the abdomen when the VAS score was significantly lower than group B（ P〈0.05 ）, and take the child and slit the skin of the two groups no significant difference（P〉0.05） ;The highest block level two quite,while the block level up to the time and T8 in group A was significantly less than the initial dose in group B（P〈0.05） ; Anesthesia duration in group A than B, head（P〈0.01 ）, light traction response in group A in group B（P〈0.05）, while BP, HR,SpOz and Apgar score between the two groups no significant difference（P〉0.05 ）. Conclusion Small doses of local anesthetics combined epidural anesthesia Fentanyl can significantly shorten the onset time of anesthe- sia,reducing the amount of local anesthetic,enhanced the anesthetic effect,and no significant effect on the newborn, can be safely used in obstetric anesthesia.