摘要
目的 比较不同浓度舒芬太尼配伍左布比卡因用于剖宫产术后病人自控硬膜外镇痛（PCEA）的效果.方法 择期拟行剖宫产术的足月、单胎产妇90例,年龄22 ～ 35岁,体重60～ 85 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为3组（n=30）：0.125％左布比卡因配伍0.4、0.6和0.8μg/ml舒芬太尼组（Ⅰ组-Ⅲ组）.术后分别行PCEA 48 h,负荷剂量5ml,持续输注剂量2 ml/h,单次给药剂量2ml,锁定时间15 min.采用视觉模拟评分（VAS评分）法评价术后48 h内疼痛程度,VAS评分≥4分时进行补救镇痛,记为自控镇痛失败.于术前、术后24和48 h时采集静脉血样,采用放射免疫分析法测定血清泌乳素浓度,采用改良Bromage评分法评价下肢运动阻滞程度,记录各组总按压次数和初乳时间,记录恶心、呕吐、瘙痒、嗜睡、呼吸抑制、心动过缓、低血压及尿潴留的发生情况.结果 与Ⅰ组比较,Ⅱ组和Ⅲ组总按压次数减少,自控镇痛失败率降低,初乳时间缩短,术后24和48 h时血清泌乳素浓度升高,Ⅲ组恶心呕吐及心动过缓发生率升高（P＜0.05）；与Ⅱ组比较,Ⅲ组总按压次数、自控镇痛失败率、初乳时间、术后24和48 h时血清泌乳素浓度差异无统计学意义（P＞0.05）,恶心呕吐及心动过缓等不良反应发生率升高（P＜0.05）；3组改良Bromage评分比较差异无统计学意义（P＞0.05）.结论 舒芬太尼配伍0.125％左布比卡因用于剖宫产术后PCEA时适宜浓度为0.6μg/ml.
Objective To compare the efficacy of patient-controlled epidural analgesia （PCEA） with different concentrations of sufentanil plus levobupivacaine after caesarean section.Methods Ninety ASA Ⅰ or Ⅱ nulliparous patients who were at full term with a singleton fetus,aged 22-35 yr,weighing 60-85 kg,undergoing elective caesarean section under combined spinal-epidural anesthesia,were randomly divided into 3 groups （n =30each）：0.125% levobupivacaine plus sufentanil 0.4,0.6 and 0.8μg/ml groups （groups Ⅰ,Ⅱ and Ⅲ）.The patients received 48 h of PCEA after operation.PCEA pump was set up with a background infusion of 2 ml/h,and a bolus dose of 2 ml with a lockout-interval of 15 min after a loading dose of 5 ml.VAS score was used to assess the intensity of pain （0 =no pain,10 =worst pain）.VAS score ≤ 3 was considered as effective analgesia.VAS score ≥4 was considered as failure of analgesia,and the rescue analgesic was given.Venous blood samples were taken before operation and at 24 and 48 h after operation to detect the serum prolactin （PRL） concentration using radioimmunoassay.The degree of motor block of lower extremities was assessed and scored using modified Bromage scale.Maternal colostrum time,the number of attempts,and adverse effects including nausea and vomiting,pruritus,somnolence,respiratory depression,bradycardia,hypotension and urinary retention were recorded after operation.Results Compared with group Ⅰ,the number of attempts and rate of failure of analgesia were significantly decreased,the maternal colostrum time was shortened,and the serum PRL concentration at 24 and 48 h after operation was significantly increased in groups Ⅱ and Ⅲ,and the incidences of adverse effects such as nausea,vomiting and bradycardia were increased in group Ⅲ （P 〈 0.05）.Compared with group Ⅱ,no significant change was found in the number of attempts,rate of failure of analgesia,maternal colostrum time,and serum PRL concentration at 24 and 48 h after operation （P 〉 0.05）,and the incidences of adverse effects such as nausea,vomiting and bradycardia were increased in group Ⅲ （P 〈 0.05）.There was no significant difference in the modified Bromage scores among the three groups （P 〉 0.05）.Conclusion When sufentanil plus 0.125 % levobupivacaine are used for PCEA,the recommonded concentration of sufentanil is 0.6 μg/ml.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2013年第9期1102-1105,共4页
Chinese Journal of Anesthesiology
关键词
布比卡因
舒芬太尼
剖宫产术
镇痛
硬膜外
镇痛
病人控制
Bupivacaine
Sufentanil
Cesarean section
Analgesia, epidural
Analgesia,patient-controlled
