2018 年第 9 期 第 13 卷

剖宫产术蛛网膜下腔注射布比卡因复合不同剂量芬太尼的麻醉效果

Anesthetic effect of subarachnoid injection of bupivacaine combined with different doses of fentanyl on patients undergoing cesarean section

作者：冶金莲马满贵王汐文马真

英文作者：

单位：810001西宁市第二人民医院麻醉科

英文单位：

关键词：剖宫产术；蛛网膜下腔麻醉；布比卡因；芬太尼

英文关键词：

• 摘要：

• 【摘要】目的    观察剖宫产术蛛网膜下腔注射布比卡因复合不同剂量芬太尼的麻醉效果。方法    选取2017年3—10月于西宁市第二人民医院行剖宫产术的产妇148例，按照随机数字表法分为观察组和对照组，每组74例。均采取蛛网膜下腔阻滞麻醉方法进行手术，对照组注入0.5%布比卡因2 ml＋芬太尼1 μg/kg＋10%葡萄糖溶液1 ml配置成的重比重溶液，观察组注入0.5%布比卡因2 ml＋芬太尼0.5 μg/kg＋10%葡萄糖溶液1 ml配置成的重比重溶液。观察2组麻醉药物起效时间和作用持续时间；监测2组麻醉后1、10 min的收缩压、舒张压、心率、血氧饱和度；记录2组术后24 h的疼痛视觉模拟量表（VAS）评分及疼痛程度。结果    观察组麻醉药物起效时间短于对照组［（3.3±0.4）min比（3.5±0.6）min］，药物作用持续时间长于对照组［（177±18）min比（169±19）min］，差异均有统计学意义（均P＜0.05）。观察组麻醉后1、10 min的血氧饱和度明显高于对照组［（95.3±0.5）%比（94.2±0.6）%、（93.1±0.3）%比（92.9±0.5）%］，差异均有统计学意义（均P＜0.05）。观察组VAS评分评估轻度疼痛比例明显高于、重度疼痛比例明显低于对照组［90.5%（67/74）比75.7%（56/74）、2.7%（2/74）比10.8%（8/74）］，差异均有统计学意义（均P＜0.05）。结论    剖宫产术蛛网膜下腔注射布比卡因麻醉时复合小剂量芬太尼的麻醉效果更好，麻醉起效时间更快，药物作用持续时间更长，对产妇各项生理指标的影响更小。

• 【Abstract】Objective    To analyze the effect of subarachnoid anesthesia using bupivacaine combined with different doses of fentanyl on patients undergoing cesarean section. Methods    A total of 148 cases of cesarean section with subarachnoid block anesthesia in the Second People′s Hospital of Xining from March 2017 to October 2017 were randomly divided into observation group and control group, with 74 cases in each group. The control group had 0.5% bupivacaine 2 ml＋fentanyl 1 μg/kg＋10% glucose solution 1 ml for anesthesia and the observation group had 0.5% bupivacaine 2 ml＋fentanyl 0.5 μg/kg＋10% glucose solution 1 ml. Onset time and duration of anesthesia were observed. Systolic blood pressure, diastolic blood pressure, heart rate and oxygen saturation of blood were observed 1, 10 min after anesthesia. The Visual Analogue Scale（VAS） score for pain was recorded 24 h after operation. Results    Onset time of anesthesia in the observation group was significantly shorter and duration of anesthesia was significantly longer than that in the control group［（3.3±0.4）min vs （3.5±0.6）min, （177±18）min vs （169±19）min］（P＜0.05）. At 1, 10 min after anesthesia, oxygen saturation of blood in the observation group was significantly higher than that in the control group［（95.3±0.5）% vs （94.2±0.6）%, （93.1±0.3）% vs （92.9±0.5）%］（P＜0.05）. Mild pain ratio assessed by VAS score was significantly higher and severe pain ratio was significantly lower in the observation group than those in the control group［90.5%（67/74） vs 75.7%（56/74）, 2.7%（2/74） vs 10.8%（8/74）］（P＜0.05）. Conclusion    Subarachnoid anesthesia using bupivacaine combined with low dose fentanyl shows short onset time, long duration and few adverse effect on physiological indexes in patients undergoing cesarean section.