CAJ | 학술논문

目的：：探讨不同剂量舒芬太尼联合罗哌卡因硬膜外麻醉用于急诊剖宫产术效果与不良反应。方法：120例产妇随机分为A、B、C组,每组40例,均行硬膜外麻醉。 A组予舒芬太尼10μg(1 ml)+0.5％罗哌卡因15 ml,B组予舒芬太尼15μg 1 ml+0.5％罗哌卡因15 ml,C组给予0.9％氯化钠注射液1 ml+0.5％罗哌卡因15 ml。观察术中胎儿娩出后Apgar评分,起效、无痛平面、镇痛持续时间,改良Bromage评分,视觉模拟评分( VAS)及不良反应。结果：与C组比较,A、B组起效时间、无痛平面时间、感觉阻滞达最高平面时间均缩短(P<0.01),镇痛持续时间均延长(P<0.01)。3组在切皮时VAS差异无统计学意义(P>0.05),3组在探查、取胎时的VAS和寒颤发生率差异均有统计学意义(P<0.01),3组患者术中低血压、心动过缓、恶心、呕吐和瘙痒的发生率差异均无统计学意义(P>0.05)；胎儿娩出后Apgar评分差异无统计学意义(P>0.05)。结论：在硬膜外麻醉行剖宫产术时使用罗哌卡因复合舒芬太尼可增强麻醉效果,15μg舒芬太尼复合罗哌卡因硬膜外麻醉可减轻探查取胎时内脏牵拉不适症状,减少术中寒颤的发生率。
목적：：탐토불동제량서분태니연합라고잡인경막외마취용우급진부궁산술효과여불량반응。방법：120례산부수궤분위A、B、C조,매조40례,균행경막외마취。 A조여서분태니10μg(1 ml)+0.5％라고잡인15 ml,B조여서분태니15μg 1 ml+0.5％라고잡인15 ml,C조급여0.9％록화납주사액1 ml+0.5％라고잡인15 ml。관찰술중태인면출후Apgar평분,기효、무통평면、진통지속시간,개량Bromage평분,시각모의평분( VAS)급불량반응。결과：여C조비교,A、B조기효시간、무통평면시간、감각조체체최고평면시간균축단(P<0.01),진통지속시간균연장(P<0.01)。3조재절피시VAS차이무통계학의의(P>0.05),3조재탐사、취태시적VAS화한전발생솔차이균유통계학의의(P<0.01),3조환자술중저혈압、심동과완、악심、구토화소양적발생솔차이균무통계학의의(P>0.05)；태인면출후Apgar평분차이무통계학의의(P>0.05)。결론：재경막외마취행부궁산술시사용라고잡인복합서분태니가증강마취효과,15μg서분태니복합라고잡인경막외마취가감경탐사취태시내장견랍불괄증상,감소술중한전적발생솔。
Objective:To investigate the effects and adverse reactions of different dosage of sufentanil combined with ropivacaine epidural anesthesia in caesarean section. Methods:One hundred and twenty puerperas were randomly divided into 3 groups( A,B and C group,40 cases in each group). Group A,B and C were treated with 0. 5% ropivacaine for 15 ml combined with 10 μg sufentanil for 1 ml,0. 5% ropivacaine for 15 ml combined with 15μg sufentanil for 1 ml and 0. 5% ropivacaine for 15 ml combined with 0. 9% sodium chloride injection for 1 ml,respectively. The fetal Apgar score after delivery,onset of action,painless plane,improved Bromage score, visual analogue scale( VAS) and adverse reactions in three groups were observed. Results:Compared with the group C,the onset of action,painless plane time and the highest plane time in group A and B were significantly shortened(P <0. 01),the duration of analgesia in group A and B was significantly prolonged(P<0. 01). The differences of VAS score between three groups at cutting skin were not statistically significant(P>0. 05). The differences of VAS score at exploration and delivery and incidence of shiver between three groups were statistically significant(P <0. 01). The differences of the incidence of intraoperative hypotension,bradycardia, nausea,vomiting and itching between three groups were not statistically significant(P >0. 05),the difference of Apgar score after delivery of the fetus was not statistically significant(P>0. 05). Conclusions:The application of ropivacaine combined with sufentanil in caesarean section under epidural block can significantly enhance the effect of anesthesia,and relieve viscera retracting discomfortable symptoms and reduce the incidence of shiver.