舒芬太尼和芬太尼复合罗哌卡因用于剖宫产术后硬膜外自控镇痛的临床观察

目的探讨舒芬太尼与罗哌卡因复合用于剖宫产术后硬膜外自控镇痛的效果并与等效剂量的芬太尼比较。方法择期剖宫产产妇80例,采用随机双盲法分为4组：RF1组、RS1组、RF2组和RS2组,每组20例。术后硬膜外自控镇痛分别采用芬太尼2μg/ml、舒芬太尼0.2μg/ml、芬太尼4μg/ml、舒芬太尼0.4μg/ml复合0.2%罗哌卡因,于术后镇痛开始前,开始后2h、4h、24h随访产妇,并评价VAS评分、Bromage改良运动评分,记录各时间点用药总量及产妇的一般情况和不良反应。结果镇痛开始后2h各组VAS评分较镇痛开始前均显著下降（P﹤0.01）;与其他3组比较,RS2组镇痛开始后2h时的VAS评分显著降低（P﹤0.01）,镇痛开始后24h内实际有效按压次数显著减少（P﹤0.01）,镇痛开始后2h、4h和24h的罗哌卡因用量显著降低（P﹤0.05）。结论0.4μg/ml舒芬太尼与0.2%罗哌卡因复合用于剖宫产术后硬膜外自控镇痛时能获得更满意的镇痛效果,同时显著减少罗哌卡因用量,并且不增加不良事件的发生率。

Comparison of sufentanil and fentanyl incombination with ropivaeaine in patient-controlled epidural analgesia for post-cesarean section

Objective To compare and investigate the efficiency and side effects of different doses of sufentanil or fentanyl in combination with ropivacaine in PCEA for post-cesarean section analgesia. Methods In this double-blind, randomized, controlled trial, ASA Ⅰ or Ⅱ parturients （n=80） with elective cesarean section were randomly assigned to four groups to receive different doses of sufentanil or fentanyl in combination with 0.2% ropivacaine for PCEA postoperatively： Group RF1 （fentanyl 2μg/ml with 0.2% ropivacaine; n=20）; Group RS1 （sufentanil 0.2μg/ml with 0.2% ropivacaine; n= 20）; Group RF2 （fentanyl 4μg/ml with 0.2% ropivacaine; n=20）; Group RS2 （sufentanil 0.4μg/ml with 0.2% ropivacaine; n=20）. VAS, modified Bromage scales and the consumption of ropivacaine were recorded at before and 2, 4 and 24 hours after PCEA started. Complications and side effects were charted if occurred. Results VAS of Group RS2 significantly decreased compared with other groups at 2 hours after PCEA started （P 〈 0.01）. The delivery frequency of PCEA and the ropivacaine consumption in 24 hours after PCEA started were significantly decreased in Group RS2 compared with other groups （P 〈 0.01 and P 〈 0.05 respectively）. The modified Bromage scale and the incidence of side effects had no significant difference among four groups. Conclusions Sufentanil 0.4μg/ml in combination with 0.2% ropivaeaine, compared with other three groups, can provide better postoperative pain control for cesarean section through PCEA, meanwhile decrease the ropivacaine consumption and the delivery frequency.