郭凤英

【摘要】 目的：探討剖宫产术中罗哌卡因复合舒芬太尼腰硬联合麻醉的应用及对新生儿Apgar评分的影响。方法：选取2018年9月-2019年9月于本院住院的116例产妇，将其随机分为对照组和研究组，每组58例。两组产妇均行腰硬联合麻醉剖宫产，对照组采用罗哌卡因麻醉，研究组在对照组基础上联合舒芬太尼。比较两组产妇手术开始时的血压、心率情况，比较两组镇痛效果、手术时间、麻醉起效时间、镇痛维持时间，比较两组新生儿出生即刻和1、5 min时身体状况情况，比较两组安全性。结果：研究组收缩压、心率均低于对照组，舒张压高于对照组，差异均有统计学意义（P<0.05）。研究组Ⅲ、Ⅱ级镇痛例数均少于对照组，0级镇痛例数多于对照组，差异均有统计学意义（P<0.05）。两组手术时间、麻醉起效时间比较，差异均无统计学意义（P>0.05）;研究组镇痛维持时间长于对照组，差异有统计学意义（P<0.05）。两组新生儿Apgar出生即刻和1、5 min时的Apgar评分比较，差异均无统计学意义（P>0.05）。研究组的不良反应发生率低于对照组，差异有统计学意义（P<0.05）。结论：将罗哌卡因复合舒芬太尼应用在腰硬联合麻醉的剖宫产术中，可较好地维持产妇血流动力学稳定，有效提高手术安全性，协同作用下麻醉镇痛效果明显增强，同时对新生儿身体健康无明显影响，值得临床推广应用。

【关键词】 新生儿Apgar评分 腰硬联合麻醉 罗哌卡因 舒芬太尼 镇痛

Application of Ropivacaine and Sufentanil Combined with Lumbar and Epidural Anesthesia in Cesarean Section and Its Effect on Apgar Score of Newborn/GUO Fengying. //Medical Innovation of China， 2021， 18（05）： 0-067

[Abstract] Objective： To explore the application of Ropivacaine and Sufentanil combined with lumbar and epidural anesthesia in cesarean section and its effect on Apgar score of newborn. Method： A total of 116 parturient women who were hospitalized in our hospital from September 2018 to September 2019 were selected. They were randomly divided into control group and study group， 58 cases in each group. Both groups were given cesarean section under combined spinal and epidural anesthesia， the control group was anesthetiized with Ropivacaine， and the research group was combined with Sufentanil on the basis of the control group. The blood pressure and heart rate of the two groups were compared at the beginning of the operation. The analgesic effect， operative time， onset time of anesthesia and analgesic maintenance time were compared between the two groups. The physical conditions of newborns immediately after birth， 1 and 5 min were compared between the two groups， and the safety of the two groups was compared. Result： The systolic blood pressure and heart rate in the study group were lower than those in the control group， while the diastolic blood pressure was higher than that in the control group， with statistical significance （P<0.05）. The number of grade Ⅲ and grade Ⅱ analgesia cases in the study group were less than those in the control group， and the number of grade 0 analgesia cases was more than that in the control group， the differences were statistically significant （P<0.05）. There were no significant differences in the operation time and the onset time of anesthesia between the two groups （P>0.05）. The duration of analgesia in the study group was longer than that in the control group， the difference was statistically significant （P<0.05）. There were no significant differences in Apgar scores immediately after birth， 1 min and 5 min between the two groups （P>0.05）. The incidence of adverse reactions in the study group was lower than that in the control group， the difference was statistically significant （P<0.05）. Conclusion： The application of Ropivacaine and Sufentanil in combined spinal epidural anesthesia for cesarean section can better maintain the stability of maternal hemodynamics， effectively improve the safety of operation， significantly enhance the analgesic effect of anesthesia under the synergistic effect， and have no significant impact on the health of newborns， which is worthy of clinical application.

[Key words] Neonatal Apgar score Combined with lumbar and epidural anesthesia Ropivacaine Sufentanil Analgesia

First-authors address： Changchun Maternity Hospital， Changchun 130042， China

doi：10.3969/j.issn.1674-4985.2021.05.017

近几年由于多种因素影响，如社会水平、生活水平、个人心理等，选择剖宫产手术的孕产妇越来越多，剖宫产已是妇产科常见的一种助产术式[1]。由于剖宫产术的特点和产妇及胎儿特殊的生理变化，为确保围产期母婴健康、剖宫产术的顺利进行，對术中骶神经阻滞完善、肌肉松弛、镇痛完全等麻醉的要求比较严格[2]。罗哌卡因是剖宫产术麻醉常用药物，具有运动感觉阻滞分离效果，对神经和心脏产生的毒副作用较小，属于长效酚胺类局麻药类，但罗哌卡因不能有效阻滞内脏神经是其作为麻醉用药的一大缺点，所以剖宫产术中探查、取胎时产妇会出现明显内脏牵拉痛[3]。……