摘要
目的:探讨舒芬太尼复合罗哌卡因硬膜外麻醉对行剖宫产术患者免疫功能及应激指标的影响。方法:选取2017年1月至2018年5月重庆市巴南区人民医院收治的拟行硬膜外麻醉的剖宫产术患者80例,以随机数字表法分为观察组和对照组,每组40例。对照组患者给予0.75%罗哌卡因麻醉,观察组患者给予舒芬太尼复合0.75%罗哌卡因麻醉。观察两组患者的麻醉效果、免疫指标水平、术中并发症发生情况、新生儿窒息情况及Apgar评分,比较麻醉前(T_0)、给药10 min时(T_1)、切皮时(T_2)、胎儿取出时(T_3)及拔管时(T_4)的心率(HR)、平均动脉压(MAP)、皮质醇(Cor)和去甲肾上腺素(NE)水平。结果:观察组患者麻醉起效时间和镇痛持续时间明显优于对照组,差异均有统计学意义(P<0.05);两组患者肌松评分的差异无统计学意义(P>0.05)。T_1、T_2、T_3及T_4时,观察组患者MAP、HR水平明显低于对照组,差异均有统计学意义(P<0.05);观察组患者各时间点MAP、HR水平的差异均无统计学意义(P>0.05)。T_2、T_3及T_4时,两组患者血清Cor、NE水平较T_0时明显升高,但观察组患者血清Cor、NE水平明显低于对照组,差异均有统计学意义(P<0.05)。术毕、术后3 d,两组患者外周血CD3^+、CD4^+及CD4^+/CD8^+水平较术前明显降低,但观察组患者CD3^+、CD4^+及CD4^+/CD8^+水平明显高于对照组,差异均有统计学意义(P<0.05)。观察组、对照组患者术中并发症发生率分别为5.00%(2/40)、10.00%(4/40),差异无统计学意义(P>0.05)。两组新生儿窒息率、1及5 min Apgar评分的差异均无统计学意义(P>0.05)。结论:舒芬太尼能够提高行罗哌卡因硬膜外麻醉剖宫产术患者的麻醉效果,减弱患者术中血流动力学波动,降低机体应激反应,改善术后免疫功能。
OBJECTIVE: To probe into the effects of sufentanil combined with ropivacaine in epidural anesthesia on immunologic function and stress indices in patient undergoing caesarean section. METHODS: 80 patients undergoing caesarean section admitted into Banan People’s Hospital of Chongqing from Jan. 2017 to May 2018 were selected and divided into observation group and control group via random number table, with 40 cases in each group. The control group was given 0.75% of ropivacaine for anesthesia, while the observation group was given sufentanil combined with 0.75% of ropivacaine. The anesthetic effects, immune indices levels, incidences of intraoperative complications, incidences of neonatal asphyxia and Apgar score of both groups were observed. The heart rate (HR), mean arterial pressure (MAP), cortisol (Cor) and norepinephrine (NE) levels at before anesthesia (T0), 10 min after administration (T1), skin incision (T2), fetus removal (T3) and extubation (T4). RESULTS: The anesthetic onset time and duration of analgesia of observation group were significantly better than those of the control group, with statistically significant difference (P<0.05);there was no statistical significance in difference in the muscle relaxation scores between two groups (P>0.05). At T1, T2, T3 and T4, the MAP and HR levels of observation group were significantly lower than those of the control group, with statistically significant differences (P<0.05);while there were no statistical significance in differences in MAP and HR levels among different time points in observation group (P>0.05). At T2, T3 and T4,the serum Cor and NE levels of both groups were significantly higher than that of T0, while the serum Cor and NE levels of observation group were significantly lower than those of the control group (P<0.05). At the end of operation and 3 days after operation, the CD3^+, CD4^+ and CD4^+/CD8^+ levels in peripheral blood of both groups were significantly lower than those of before operation, while those of the observation group were significantly higher than the control group, with statistically significant differences (P<0.05). The incidences of intraoperative complications of observation group and control group were respectively 5.00%(2/40) and 10.00%(4/40), the difference had no statistical significance (P>0.05). There were no statistical significance in differences in the incidences of neonatal asphyxia, Apgar scores at 1min and 5 min between the two groups (P>0.05). CONCLUSIONS: Sufentanil can improve the anesthetic effect of ropivacaine for epidural anesthesia in patients undergoing caesarean section, weaken the hemodynamic fluctuation during operation, reduce stress response and improve postoperative immunologic function.
作者
钱科
颜娅
QIAN Ke;YAN Ya(Dept.of Anesthesiology,Banan People’s Hospital of Chongqing,Chongqing 401320,China;Dept.of Anesthesiology,Chongqing Health Center for Women and Children,Chongqing 401147,China)
出处
《中国医院用药评价与分析》
2019年第3期283-286,共4页
Evaluation and Analysis of Drug-use in Hospitals of China
基金
2017年重庆市卫生计生委医学科研项目(No.2017MSXM112)
关键词
剖宫产术
硬膜外麻醉
舒芬太尼
应激反应
免疫功能
Cesarean section
Epidural anesthesia
Sufentanil
Stress response
Immunologic function
