本文關(guān)鍵詞：腰麻下羅哌卡因復(fù)合硬膜外不同劑量舒芬太尼用于剖宮產(chǎn)麻醉的臨床效果觀察　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 剖宮產(chǎn) 羅哌卡因 腰麻聯(lián)合硬膜外麻醉 舒芬太尼 合理劑量

【摘要】：目的:腰麻是當(dāng)前臨床剖宮產(chǎn)術(shù)式的主要麻醉方式。腰麻下的剖宮產(chǎn)手術(shù)因?yàn)橐矔?huì)與其他腰麻手術(shù)存在著類似相同的諸多不足之處,主要是其腰麻所用藥物造成的各種不良反應(yīng)以及血流動(dòng)力學(xué)的紊亂;另外,腰麻下的剖宮產(chǎn)手術(shù)也會(huì)造成不同程度的運(yùn)動(dòng)恢復(fù)延遲,進(jìn)而對(duì)產(chǎn)婦術(shù)后恢復(fù)也造成了一定的影響。因此,強(qiáng)化剖宮產(chǎn)麻醉不良反應(yīng)的研究也成為了麻醉醫(yī)師研究主要方向之一。目前經(jīng)大量臨床研究發(fā)現(xiàn),硬膜外單次給予舒芬太尼最大劑量范圍為10~20ug,但對(duì)舒芬太尼最佳鎮(zhèn)痛量效關(guān)系仍未達(dá)成一致。本文則就腰硬聯(lián)合麻醉下相同劑量羅哌卡因+不同劑量舒芬太尼對(duì)剖宮產(chǎn)患者麻醉結(jié)果及術(shù)后鎮(zhèn)痛進(jìn)行分析比較,以期為提高剖宮產(chǎn)臨床麻醉合理劑量的應(yīng)用提供更多的參考與借鑒。方法:選取2016年1月~2016年12月滄州市人民醫(yī)院(頤和婦產(chǎn)分院)擬行擇期剖宮產(chǎn)手術(shù)的90例健康、單胎足月待產(chǎn)婦,ASAⅠ~Ⅱ級(jí)。本研究經(jīng)本院醫(yī)學(xué)倫理委員會(huì)通過,且均獲得患者知情同意。按照相同腰麻和不同硬膜外藥物配比隨機(jī)將研究資料分為三組:每組30例。A組:蛛網(wǎng)膜下腔0.75%羅哌卡因2ml+10%葡萄糖1ml(共2.5ml);硬膜外腔舒芬太尼20ug。B組:蛛網(wǎng)膜下腔0.75%羅哌卡因2ml+10%葡萄糖1ml(共2.5ml);硬膜外腔舒芬太尼15ug。C組:蛛網(wǎng)膜下腔0.75%羅哌卡因2ml+10%葡萄糖1ml(共2.5ml);硬膜外腔舒芬太尼10ug。三組于產(chǎn)婦入室后,立即開放靜脈通路,選擇L2~3間隙為穿刺點(diǎn),確定進(jìn)入硬膜外腔后用腰麻針行硬脊膜穿刺,待有突破感之后,拔出針芯;見清澈腦脊液回流以后注入0.75%羅哌卡因2ml+10%葡萄糖1ml共2.5ml;撤出腰麻針后,硬膜外腔注入不同劑量的舒芬太尼+0.9%生理鹽水5ml,并置入硬膜外導(dǎo)管。完成后患者立即恢復(fù)平臥位,待患者痛覺消失后,開始手術(shù)。術(shù)畢連接硬膜外鎮(zhèn)痛泵。觀測指標(biāo):(1)感覺阻滯平面測定:每間隔5分鐘用針刺測定疼痛感覺阻滯平面;給藥后5分鐘之內(nèi),則1分鐘測定一次;以后每間隔5分鐘測定一次;至手術(shù)開始切皮時(shí)。手術(shù)過程中每10分鐘測定一次疼痛感覺消失平面。觀測、記錄對(duì)疼痛感覺阻滯起效時(shí)間(從首次注入至T6平面疼痛感覺消失時(shí)間)進(jìn)行記錄,并同時(shí)觀測、記錄疼痛感覺阻滯平面上界(以脊髓階段表示)。(2)術(shù)后鎮(zhèn)痛質(zhì)量的評(píng)定:采用視覺模擬評(píng)分標(biāo)準(zhǔn)(VAS)對(duì)產(chǎn)婦離室、術(shù)后2小時(shí)、6小時(shí)、12小時(shí)的鎮(zhèn)痛質(zhì)量進(jìn)行評(píng)分。0分:產(chǎn)婦無痛,10分為劇烈的疼痛。1~10分疼痛程度逐漸加重。記錄術(shù)前、術(shù)后24h靜脈血生化指標(biāo)。(3)觀測并記錄三組產(chǎn)婦的血流動(dòng)力學(xué)改變狀況,記錄各組實(shí)施麻醉前(T0),實(shí)施麻醉后1分鐘(T1),3分鐘(T2),切皮(T3),胎兒娩出時(shí)(T4),胎兒娩出后5分鐘(T5),離室(T6),離室2小時(shí)(T7),離室6小時(shí)(T8)的ECG(心電圖)、BP(無創(chuàng)血壓)、HR(心率)、RR(呼吸頻率)、SPO2(脈搏血氧飽和度)。(4)觀察新生兒娩出后1分鐘和5分鐘Apgar評(píng)分;觀察惡心、嘔吐、瘙癢、尿潴留、寒戰(zhàn)及低血壓等并發(fā)癥的發(fā)生率。結(jié)果:1三組研究資料的麻醉效果比較存在著一定的差異;其中A組和B組其麻醉質(zhì)量效果明顯優(yōu)于C組(P0.05)。2對(duì)三組研究資料的疼痛VAS評(píng)分分析發(fā)現(xiàn),A、B兩組的疼痛VAS評(píng)分無明顯統(tǒng)計(jì)學(xué)差異(P0.05);但A、B兩組VAS評(píng)分結(jié)果明顯優(yōu)于C組而且具明顯統(tǒng)計(jì)學(xué)差異(P0.05)。3術(shù)前三組觀測研究對(duì)象的無創(chuàng)血壓、心率、氧飽和度均無統(tǒng)計(jì)學(xué)差別(P0.05);術(shù)后,三組研究對(duì)象的脈搏血氧飽和度也無統(tǒng)計(jì)學(xué)差別(P0.05);但三組研究對(duì)象于術(shù)后各時(shí)間點(diǎn)的血壓與心率存在較大差別。A、B兩組與C組對(duì)比SBP在T2、T3、T7均下降(P0.05);A組DBP在T2、T3、T4、T8下降(P0.05);而B組DBP在T3、T4、T8下降(P0.05);A、B兩組的HR在T2、T3、T7上升而在T8下降(P0.05)。與T0比較SBP,A組在T2、T3、T4、T7降低(P0.05),B組SBP在T2、T3、T4、T8下降(P0.05),C組SBP在T2下降(P0.05);與T0比較DBP,A組在T2、T3、T4、T5、T6、T7、T8降低,B組在T2、T3、T4、T6、T7、T8降低,C組在T2、T3、T4下降(P0.05)。與T0對(duì)比HR,A、B、C組均在T2、T3、T4上升而A、B組在T7、T8下降(P0.05)。4各組研究對(duì)象運(yùn)動(dòng)恢復(fù)時(shí)間、胎兒Apgar評(píng)分、最大運(yùn)動(dòng)阻滯程度的統(tǒng)計(jì)學(xué)比較無差異(P0.05)。5三組研究對(duì)象,均未出現(xiàn)新生兒窒息、低氧血癥、心動(dòng)過緩等嚴(yán)重不良反應(yīng);但各組均出現(xiàn)輕度惡心、嘔吐、寒戰(zhàn)、瘙癢、尿潴留,B組、C組與A組比較有明顯統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:蛛網(wǎng)膜下腔0.75%羅哌卡因2ml+10%葡萄糖1ml(共2.5ml);硬膜外腔注入舒芬太尼15ug+%0.9生理鹽水稀釋至5ml,能夠在剖宮產(chǎn)手術(shù)中得到最滿意的麻醉效果與術(shù)后鎮(zhèn)痛效果;且能在麻醉效果與不良反應(yīng)間達(dá)到更理想的平衡。因此,該麻醉方案為更加適用于臨床剖宮產(chǎn)麻醉及術(shù)后鎮(zhèn)痛的合理劑量。
[Abstract]:Objective: spinal anesthesia is the main mode of current clinical cesarean section under spinal anesthesia. The cesarean section because there will be a lot of shortcomings similar with other spinal surgery, which is mainly caused by spinal anesthesia with drug adverse reactions and hemodynamic disorder; in addition, the waist anesthesia for cesarean section will cause delayed recovery of different degrees of movement, and also caused some impact on maternal postoperative recovery. Therefore, strengthening the research of cesarean section anesthesia adverse reactions has become one of the main directions of research at present. By a large number of anesthesiologists clinical study found that single epidural sufentanil maximum the dose range of 10~20ug, but the best analgesic sufentanil dose effect relationship has not yet agreed. This paper is under combined spinal epidural anesthesia with the same dose of ropivacaine combined with different doses of sufentanil on patients with cesarean section anesthesia The results of comparison and analysis of drunk analgesia after operation, in order to provide reference for the application of more reasonable and improve the cesarean section clinical anesthesia dose. Methods: from January 2016 December ~2016 Cangzhou People's Hospital (Yihe maternity branch) undergoing cesarean section in 90 cases of healthy, full-term singleton pregnant women, ASA I II. The study by the medical ethics committee of the hospital through, and obtain informed consent of patients. In the same spinal anesthesia and epidural drug ratio of different random research data will be divided into three groups:.A group, 30 cases in each group: subarachnoid 0.75% ropivacaine 2ml+10% glucose 1ml (CO 2.5ml); epidural cavity subarachnoid sufentanil 20ug.B group: 0.75% ropivacaine 2ml+10% glucose 1ml (2.5ml); group 15ug.C: epidural sufentanil subarachnoid 2ml+10% ropivacaine 0.75% 1ml glucose (2.5ml); epidural sufentanil three 10ug. In women after the burglary, immediately open venous access, select the L2~3 clearance for the puncture point, determined to enter the epidural cavity after spinal anesthesia needle for dural puncture, after a breakthrough, pull out the needle core; clear cerebrospinal fluid reflux after injection of 0.75% ropivacaine 2ml+10% glucose 1ml 2.5ml; spinal anesthesia after needle withdrawal, epidural injection of different doses of sufentanil +0.9% saline 5ml, and placed in the epidural catheter. Patients recovered immediately after the completion of the supine position after the patients pain disappeared after surgery. The surgery began to connect epidural analgesia pump. Observation index: (1) the level of sensory block was determined every 5 minutes to measure the pain with acupuncture the level of sensory block; after administration of 5 minutes, 1 minutes after the test once every 5 minutes; Determination of time; to surgical incision at the start. During the operation was measured every 10 min pain feeling disappeared. Plane observation, records of 鐤肩棝鎰熻闃繪粸璧鋒晥鏃墮棿(浠庨嬈℃敞鍏ヨ嚦T6騫抽潰鐤肩棝鎰熻娑堝け鏃墮棿)榪涜璁板綍,騫跺悓鏃惰嫻，

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