布比卡因复合舒芬太尼重密度蛛网膜下腔阻滞用于剖宫产麻醉的效果

目的观察布比卡因复合舒芬太尼重密度蛛网膜下腔阻滞用于剖宫产手术的麻醉效果，以及对患者和胎儿的影响。方法选择行择期剖宫产手术患者80例，随机分为布比卡因组（B组）和布比卡因复合舒芬太尼组（BS组），每组各40例。监测并记录患者麻醉前、蛛网膜下腔给药后各时间点收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、HR、SpO2的变化。记录蛛网膜下腔给药后药物起效时间、运动恢复时间和痛觉恢复时间，评价两组患者肌松效果，记录两组患者术中牵拉反应、新生儿Apgar评分以及麻醉并发症。结果两组患者药物起效时间、运动恢复时间、肌松效果、新生儿Apgar评分比较差异均无统计学意义。两组患者给药后3～10min MAP有明显下降，而给药后30～120min MAP与给药前比较差异无统计学意义。B组患者术中发生牵拉反应率为27．5％，而Bs组患者术中无牵拉反应。BS组患者痛觉恢复时间较B组显著延迟（P〈0．01），BS组患者术后出现一过性轻度皮肤瘙痒率为17．5％。结论小剂量舒芬太尼可以增强和延长蛛网膜下腔阻滞的镇痛效果，而不影响布比卡因的肌松效果和药物作用时间，有利于患者下肢及早恢复运动功能。

Sulfentanil combined with bupivacaine for subarachnoid block on cesarean section patients

Objective To observe the anaesthetic effect of sulfentanil combined with bupivacaine for subarachnoid block on cesarean section patients and the influence on the patient and fetus. Methods Eighty patients who were scheduled for elective cesarean section under subarachnoid block, were distributed into two groups ： bupivacaine with no sulfentanil （group B） and bupivacaine with sulfentanil （group BS）. Detected SBP, DBP, MAP, HR, SpO2 before and after anesthesia. The time of drug onset,motor recovery and pain recovery were recorded, the effect of muscle relaxation was evaluated, and the drag reaction, neonatal Apgar score and anesthesia complication were recorded. Results There was no significant difference in the time of drug onset and motor recovery, muscle relaxation, neonatal Apgar score between the two groups. MAP was lower after 3-10 min of anesthesia than before anesthesia,but there was no significant difference after 30-120 min of anesthesia in the two groups. The rate of drag reaction was 27.5% in group B, but no case in group BS. The time of pain recovery was longer in group BS than that in group B （P 〈 0.01 ）. The rate of temporary itch of skin after operation was 17.5% in group BS. Conclusion The addition of sulfentanil to hyperbaric bupivacaine provides adequate anesthesia for cesarean section and good postoperative analgesia.