2023 年第 1 期 第 18 卷

剖宫产术中应用舒芬太尼对卡前列素所诱发不良反应的影响

Effect of sufentanil on adverse reactions induced by carboprost during cesarean section

作者：陈方园林多茂

英文作者：Chen Fangyuan Lin Duomao

单位：首都医科大学附属北京安贞医院麻醉中心，北京100029

英文单位：Anesthesia Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：舒芬太尼；卡前列素；不良反应；剖宫产

英文关键词：Sufentanil;Carboprost;Adversereactions;Cesareansection

• 摘要：

• 目的  探讨在剖宫产术中静脉给予低剂量舒芬太尼对宫体注射卡前列素所诱发的恶心呕吐等不良反应的影响。方法  选取2022年1—5月在首都医科大学附属北京安贞医院住院，具有子宫收缩乏力危险因素，且拟定术中宫体注射卡前列素的剖宫产产妇62例作为研究对象。完全随机分为观察组和对照组，各31例。在胎儿娩出后，观察组给予0.1 μg/kg舒芬太尼静脉注射，对照组给予等容积0.9%氯化钠注射液。监测2组产妇的心率、平均动脉压(MAP)、脉搏血氧饱和度（SpO2），观察恶心呕吐、胸闷、心悸、面部潮红等不良反应。记录补液量、出血量等指标。对恶心呕吐及术后疼痛进行视觉模拟量表评分。同时对恶心呕吐的危险因素进行分析。结果观察组的恶心呕吐发生率明显低于对照组［29.0%（9/31）比74.2%（23/31）］，胸闷、心悸的发生率也低于对照组，差异均有统计学意义（均P<0.01）。在使用卡前列素后，观察组的心率和MAP的波动比对照组小，在注射后5、15 min最明显。使用舒芬太尼是恶心呕吐的保护因素（比值比=0.142，95%置信区间：0.049～0.460，P<0.001），而术后疼痛是发生恶心呕吐危险因素（比值比=4.533，95%置信区间：1.492～15.130，P=0.009）。结论  在蛛网膜下腔麻醉下行剖宫产时，同时静脉给予低剂量舒芬太尼可以有效减轻宫体注射卡前列素所诱发的恶心呕吐等不良反应。有效的疼痛管理可以减轻恶心呕吐的发生。

• Objective  To investigate the effect of intravenous administration of low-dose sufentanil on adverse effects such as nausea and vomiting induced by intrauterine body injection of carboprost during cesarean section. Methods  Totally 62 cesarean section parturients were selected as the study subjects, who had risk factors of uterine contractility and intended to be injected with carboprost in the uterine body during the operation in Beijing Anzhen Hospital, Capital Medical University from January to May 2022. They were randomly divided into observation group and control group, with 31 cases in each group. After fetus delivered, the observation group was given 0.1 μg/kg sufentanil intravenous injection, and the control group was given the same dose of 0.9% sodium chloride injection intravenous injection. The heart rate, mean arterial pressure(MAP) and pulse oxygen saturation(SpO2) of parturients were monitored in both groups, and adverse reactions such as nausea and vomiting, chest tightness, palpitation and facial flushing were observed. The amount of rehydration fluid, bleeding and other indicators were recorded. Visual analog scale score was performed for nausea and vomiting and postoperative pain. Risk factors for nausea and vomiting were analyzed. Results  The incidence of nausea and vomiting was significantly lower in observation group than that in control group［29.0%（9/31） vs 74.2%（23/31）］, and the incidences of chest tightness and palpitation were lower than those in control group(all P<0.01). After carboprost injection, the heart rate and MAP fluctuated less in observation group than those in control group, and were most pronounced at 5 and 15 min after injection. The use of sufentanil was a protective factor of nausea and vomiting （odds ratio=0.142， 95% confidence interval: 0.049-0.460， P<0.001）, while postoperative pain was a risk factor （odds ratio=4.533， 95% confidence interval: 1.492-15.130， P=0.009）. Conclusions  During cesarean delivery under subarachnoid anaesthesia, concomitant intravenous administration of low-dose sufentanil is effective in reducing adverse reactions such as nausea and vomiting induced by intrauterine body injection of carboprost. Effective pain management can reduce the incidence of nausea and vomiting.