芬太尼与舒芬太尼鞘内给药预防剖宫产手术寒战

摘要

目的 探讨罗哌卡因复合小剂量芬太尼与舒芬太尼鞘内给药在剖宫产手术麻醉中预防寒战的有效性和安全性.方法 选择剖宫产产妇120例,按随机数字表法分为3组,均采用腰-硬联合麻醉,其中A组40例含芬太尼25 μg、罗哌卡因10 mg,B组40例含舒芬太尼5 μg、罗哌卡因10 mg,C组40例只给予罗哌卡因12 mg,均用生理盐水稀释为2 ml.观察各组麻醉效果,寒战出现的时点、强度和发生率;记录麻醉后低血压、恶心呕吐、皮肤瘙痒等不良反应的发生率以及新生儿Apgar评分等情况.结果 3组麻醉效果比较,差异无统计学意义(P＞0.05);寒战发生率和强度比较,A组、B组显著低于C组(P＜0.05),A组、B组比较,差异无统计学意义(P＞0.05);胎儿娩出前与胎儿娩出后寒战发生率,C组高于A组、B组,差异有统计学意义(P＜0.05),A组、B组差异无统计学意义(P＞0.05);皮肤瘙痒发生率B组显著高于A组、C组(P＜0.05),A组、C组比较差异无统计学意义(P＞0.05);低血压、恶心呕吐的发生率和新生儿出生后1 min、5 min Apgar评分等3组比较差异无统计学意义(P＞0.05).结论 罗哌卡因复合芬太尼或舒芬太尼鞘内给药在剖宫产手术麻醉中均能有效预防寒战发生,而芬太尼皮肤瘙痒的发生率低,更适用于预防剖宫产手术中寒战.%Objective To investigate the safe and efficacy of preventing shivering of parturients during cesarean section by injecting ropivacaine combined with fentanyl or sufentanyl into the subarachniod space. Methods One hundred and twenty ASA Ⅰ - Ⅱ parturients undergoing cesarean cection were randomly divided into three groups. Using the combined spinal and epidural anesthesia( CSEA ), the 40 cases in group A received injecting ropivacaine of 10 mg mixed with fentanyl of 25 μg into the subarachniod space,the 40 cases in group B received injecting ropivacaine of 10 mg mixed with sufentanyl of 5 μg into the subarachniod space,the 40 cases in group C received injecting ropivacaine of 12 mg into the subarachniod space. The drug of each group was diluted to 2 ml with normal saline. The effect of anesthesia, the time point, incidence and degree of shivering were observed; The incidence of adverse reactions such as hypotension after anesthesia, nausea and vomiting, itch of skin, and the Apgar score were recorded. Results There was no significant difference in effect of anesthesia among three groups( P >0. 05 ). The incidence and the degree of shivering in group A and or group B were significantly lower than those in group C( P <0. 05 ),and they showed no significant difference between group A and group B( P >0. 05 ). The incidence of shivering before the fetal birth or after the fetal birth in group C was significantly higher than those in group A, group B( P < 0. 05 ), and there was no significant difference between group A and group B( P >0. 05 ). The incidence of itch in group B was significantly higher than those in group A,group C( P <0. 05 ),and there was no significant difference between group A and group C( P>0. 05 ). There were no significant differences in the incidence of hypotension, nausea and vomiting, and the Apgar score at 1 min and 5 min among three groups( P >0. 05 ). Conclusion The intrathecal ropivacaine combined with fentanyl or sufentanyl during cesarean section may prevent the occurrence of shivering. However, ropivacaine 10 mg mixed fentanyl 25 μg,which has a low incidence of itch,and is more suitable for preventing the occurrence of shivering during cesarean section.