摘要
目的探讨小剂量舒芬太尼复合布比卡因腰硬联合麻醉用于妊高征剖宫产术的有效性及安全性。方法选择单胎,患有妊高征、子痫前期择期行剖宫产术的产妇60例,随机均分为三组,根据腰麻用药不同剂量及配方,分为D组(布比卡因7.5mg)、G组(布比卡因10mg)、H组(舒芬太尼5μg复合布比卡因7.5mg)。观察并记录各组麻醉前、麻醉后5min、10min、15min、30min的MAP、HR的变化;各组麻醉感觉阻滞起效时间、运动阻滞起效时间、麻醉最高平面、运动阻滞持续时间及肌松效果评价;记录新生儿出生后1min、5min的Apgar评分及各组胸闷、寒颤、恶心、呕吐、呼吸抑制的发生率。结果三组麻醉后5min的MAP、HR均较麻醉前降低,而G组较其它组下降更明显(P<0.05),其中12例需静注麻黄碱才能维持,且胸闷、寒颤、恶心、呕吐的发生率较D组、H组高。各组麻醉感觉阻滞起效时间、运动阻滞起效时间差异无显著性(P>0.05),D组有10例麻醉最高平面达不到手术要求,需硬膜外追加局麻醉药,与G组、H组比较差异有显著性(P<0.05)。各组新生儿出生后1min、5min的Apgar评分差异无显著性(P>0.05)。结论小剂量舒芬太尼5μg复合小剂量布比卡因7.5mg腰硬联合麻醉对妊高征患者血流动力学影响小,起效快,阻滞完善,肌松效果佳,运动阻滞持续时间短,不良反应少,患者感觉舒适,值得临床推广。
Objective To evaluate the efficacy and safety of combined spinal epidural anesthesia （CSEA） of small dose of sufentanil combined with bupivacaine in cesarean section for patients with pregnancy induced hypertension （PIH）. Methods 60 one-fetus pregnant women, who had PIH,pre-eelampsia and was going to undergo cesarean section were randomly divided into 3 groups on average ： group D（with7.5 mg bupivacaine） ,groupG（witb10 mg bupivacaine）, and groupH （with 5 μg sufentanil＋7.5 mg bupivacaine） according to different dosages and formula of spinal anesthesia. Their MAP and HR changes at the 5th min, 10th min, 15th min and 30th rain before and after anesthesia were observed and recorded, respectively. The onset time of sensory block and motor block, the highest level of anesthesia,duration of sensory and motor block and muscle loose effect in all of the groups were evaluated and recorded. The Apgar score of newborns were recorded in 1 min and 5 mins after birth. In addition, the incidence rates of chest congestion, rigors, nausea, vomiting and respiratory depression in the 3 groups were recorded. Results 5 mins after anesthesia, the MAP, H R of all groups reduced, but group G reduced more obviously than other groups（ P 〈0.05）. 12 patients of group G needed ephedrine injection and the incidence rates of chest congestion, rigors, nausea and vomiting were higher than those in group D and group H. There was no significant difference in the comparison of onset time of sensory block and motor block among the 3 groups（ P 〉0.05）. Besides, the highest level of anesthesia in 10 cases of group D could not meet the demand of the surgery. It is necessary to add local anesthesia to epidural anesthesia,and there was significant difference in this aspect between group D and group H（ P〈0.05）. In addition,1 rain and 5 mins after the birth,there was no significant difference in Apgar scores of the newborns（ P 〉0. 05）. Conclusion CSEA of small dose of 5btg sufentanil combined with 7.5rag bupivaeaine has little hemodynamics influence on patients with PIH. It has quick effect, excellent blockade, good effect of muscle relaxation, short duration of sensory and mo-tor block, few adverse reactions and discomfort on patients. Thus,it is worth popularizing.
出处
《右江医学》
2013年第1期7-10,共4页
Chinese Youjiang Medical Journal
