瑞芬太尼辅助腰椎-硬膜外麻醉用于急诊剖宫产手术的临床观察

目的观察瑞芬太尼辅助腰椎-硬膜外麻醉减轻患者疼痛及对新生儿Apgar评分和新生儿娩出时SpO2影响。方法剖宫产产妇120例随机分为两组,每组60例,选用L3~4间隙,B-D型腰椎-硬膜外联合穿刺确认成功后,用25 G腰穿针行蛛网膜下腔穿刺,见脑脊液回流后注入腰麻药0.75%的盐酸布比卡因1.2 ml,向头侧置入导管3.5 cm,麻醉平面控制在T10,A组为对照组,术中不辅助瑞芬太尼。B组为观察组,手术开始时静脉滴注瑞芬太尼1.0μg/（kg·h）。结果手术患者牵拉痛VAS评分B组显著低于A组,差异有统计学意义（P〈0.05）。新生儿1 min及5 min Apgar评分及SpO2比较,差异无统计学意义（P〉0.05）,两组患者术中恶心呕吐等不良反应比较,差异无统计学意义（P〉0.05）。结论小剂量的瑞芬太尼辅助腰椎-硬膜外麻醉是可行的,能减轻牵拉疼痛及对新生儿Apgar评分和新生儿娩出时SpO2影响极小,对母婴是安全的。

Clinical observation of remifentanil assisted lumbar-epidural anesthesia in emergency caesarean operation

Objective To observe the influence of remifentanil assisted lumbar-epidural anesthesia on reducing pain and Apgar score and SpO2 of newborns. Methods A total of 120 cases undergone caesarean section were randomly divided into two group, and each group contained 60 cases. After confirmed success of L3~4 clearance and B-D lumbar-epidural puncture, 25 G spinal needle was conducted for subarachnoid puncture. 1.2 ml of 0.75%anesthetic bupivacaine hydrochloride was injected after cerebrospinal fluid reflow. Insertion catheter was set cephalad for 3.5 cm. The level of anesthesia was controlled at T10. Group A was the control group and received no assisted remifentanil during operation. Group B, as the observation group, was injected by 1.0μg/（kg·h） of remifentanil at the beginning operation. Results The dragging pain VAS score of group B was obviously lower than that of group A, and the difference had statistical significance （P〈0.05）. There were no significant differences of newborns in 1 min and 5 min Apgar score and SpO2 （P〉0.05）. The difference was no statistically significant between the adverse reactions, such as nausea and vomiting, of the two groups （P〉0.05）. Conclusion Lumbar-epidural anesthesia assisted by small dose of remifentanil is feasible, and it can reduce dragging pain and has less influence on Apgar score and SpO2 of newborns, which is safe for the mother and infant.