舒芬太尼复合罗哌卡因硬膜外麻醉对行剖宫产术患者免疫功能及应激指标的影响
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摘要
目的:探讨舒芬太尼复合罗哌卡因硬膜外麻醉对行剖宫产术患者免疫功能及应激指标的影响。方法:选取2017年1月至2018年5月重庆市巴南区人民医院收治的拟行硬膜外麻醉的剖宫产术患者80例,以随机数字表法分为观察组和对照组,每组40例。对照组患者给予0.75%罗哌卡因麻醉,观察组患者给予舒芬太尼复合0.75%罗哌卡因麻醉。观察两组患者的麻醉效果、免疫指标水平、术中并发症发生情况、新生儿窒息情况及Apgar评分,比较麻醉前(T_0)、给药10 min时(T_1)、切皮时(T_2)、胎儿取出时(T_3)及拔管时(T_4)的心率(HR)、平均动脉压(MAP)、皮质醇(Cor)和去甲肾上腺素(NE)水平。结果:观察组患者麻醉起效时间和镇痛持续时间明显优于对照组,差异均有统计学意义(P<0.05);两组患者肌松评分的差异无统计学意义(P>0.05)。T_1、T_2、T_3及T_4时,观察组患者MAP、HR水平明显低于对照组,差异均有统计学意义(P<0.05);观察组患者各时间点MAP、HR水平的差异均无统计学意义(P>0.05)。T_2、T_3及T_4时,两组患者血清Cor、NE水平较T_0时明显升高,但观察组患者血清Cor、NE水平明显低于对照组,差异均有统计学意义(P<0.05)。术毕、术后3 d,两组患者外周血CD3~+、CD4~+及CD4~+/CD8~+水平较术前明显降低,但观察组患者CD3~+、CD4~+及CD4~+/CD8~+水平明显高于对照组,差异均有统计学意义(P<0.05)。观察组、对照组患者术中并发症发生率分别为5.00%(2/40)、10.00%(4/40),差异无统计学意义(P>0.05)。两组新生儿窒息率、1及5 min Apgar评分的差异均无统计学意义(P>0.05)。结论:舒芬太尼能够提高行罗哌卡因硬膜外麻醉剖宫产术患者的麻醉效果,减弱患者术中血流动力学波动,降低机体应激反应,改善术后免疫功能。
OBJECTIVE: To probe into the effects of sufentanil combined with ropivacaine in epidural anesthesia on immunologic function and stress indices in patient undergoing caesarean section. METHODS: 80 patients undergoing caesarean section admitted into Banan People's Hospital of Chongqing from Jan. 2017 to May 2018 were selected and divided into observation group and control group via random number table, with 40 cases in each group. The control group was given 0.75% of ropivacaine for anesthesia, while the observation group was given sufentanil combined with 0.75% of ropivacaine. The anesthetic effects, immune indices levels, incidences of intraoperative complications, incidences of neonatal asphyxia and Apgar score of both groups were observed. The heart rate(HR), mean arterial pressure(MAP), cortisol(Cor) and norepinephrine(NE) levels at before anesthesia(T_0), 10 min after administration(T_1), skin incision(T_2), fetus removal(T_3) and extubation(T_4). RESULTS: The anesthetic onset time and duration of analgesia of observation group were significantly better than those of the control group, with statistically significant difference(P<0.05); there was no statistical significance in difference in the muscle relaxation scores between two groups(P>0.05). At T_1, T_2, T_3 and T_4, the MAP and HR levels of observation group were significantly lower than those of the control group, with statistically significant differences(P<0.05); while there were no statistical significance in differences in MAP and HR levels among different time points in observation group(P>0.05). At T_2, T_3 and T_4,the serum Cor and NE levels of both groups were significantly higher than that of T_0, while the serum Cor and NE levels of observation group were significantly lower than those of the control group(P<0.05). At the end of operation and 3 days after operation, the CD3~+, CD4~+ and CD4~+/CD8~+ levels in peripheral blood of both groups were significantly lower than those of before operation, while those of the observation group were significantly higher than the control group, with statistically significant differences(P<0.05). The incidences of intraoperative complications of observation group and control group were respectively 5.00%(2/40) and 10.00%(4/40), the difference had no statistical significance(P>0.05). There were no statistical significance in differences in the incidences of neonatal asphyxia, Apgar scores at 1 min and 5 min between the two groups(P>0.05). CONCLUSIONS: Sufentanil can improve the anesthetic effect of ropivacaine for epidural anesthesia in patients undergoing caesarean section, weaken the hemodynamic fluctuation during operation, reduce stress response and improve postoperative immunologic function.
OBJECTIVE: To probe into the effects of sufentanil combined with ropivacaine in epidural anesthesia on immunologic function and stress indices in patient undergoing caesarean section. METHODS: 80 patients undergoing caesarean section admitted into Banan People's Hospital of Chongqing from Jan. 2017 to May 2018 were selected and divided into observation group and control group via random number table, with 40 cases in each group. The control group was given 0.75% of ropivacaine for anesthesia, while the observation group was given sufentanil combined with 0.75% of ropivacaine. The anesthetic effects, immune indices levels, incidences of intraoperative complications, incidences of neonatal asphyxia and Apgar score of both groups were observed. The heart rate(HR), mean arterial pressure(MAP), cortisol(Cor) and norepinephrine(NE) levels at before anesthesia(T_0), 10 min after administration(T_1), skin incision(T_2), fetus removal(T_3) and extubation(T_4). RESULTS: The anesthetic onset time and duration of analgesia of observation group were significantly better than those of the control group, with statistically significant difference(P<0.05); there was no statistical significance in difference in the muscle relaxation scores between two groups(P>0.05). At T_1, T_2, T_3 and T_4, the MAP and HR levels of observation group were significantly lower than those of the control group, with statistically significant differences(P<0.05); while there were no statistical significance in differences in MAP and HR levels among different time points in observation group(P>0.05). At T_2, T_3 and T_4,the serum Cor and NE levels of both groups were significantly higher than that of T_0, while the serum Cor and NE levels of observation group were significantly lower than those of the control group(P<0.05). At the end of operation and 3 days after operation, the CD3~+, CD4~+ and CD4~+/CD8~+ levels in peripheral blood of both groups were significantly lower than those of before operation, while those of the observation group were significantly higher than the control group, with statistically significant differences(P<0.05). The incidences of intraoperative complications of observation group and control group were respectively 5.00%(2/40) and 10.00%(4/40), the difference had no statistical significance(P>0.05). There were no statistical significance in differences in the incidences of neonatal asphyxia, Apgar scores at 1 min and 5 min between the two groups(P>0.05). CONCLUSIONS: Sufentanil can improve the anesthetic effect of ropivacaine for epidural anesthesia in patients undergoing caesarean section, weaken the hemodynamic fluctuation during operation, reduce stress response and improve postoperative immunologic function.
引文
[1] 王凤玫,许波,陈东生.全身麻醉对剖宫产术中孕妇循环和新生儿Apgar评分及血气分析的影响[J].中国妇产科临床杂志,2013,14(6):497-500.
[2] Hamilton BE,Martin JA,Ventura SJ.Births:preliminary data for 2012[J].Natl Vital Stat Rep,2013,62(3):1-20.
[3] 邓超,吴畏.右美托咪定对全麻剖宫产患者血流动力学及应激反应的影响[J].四川医学,2015,36(2):191-194.
[4] 梁淑敏,林颖,唐貌.利多卡因联合芬太尼在剖宫产手术硬膜外麻醉中的效果研究[J].中国计划生育和妇产科,2014,6(9):64-66.
[5] 阮北燕,陈清娟,陈健,等.不同剂量舒芬太尼与罗哌卡因复合硬膜外麻醉在剖宫产术中的应用[J].中国现代医生,2018,56(1):107-110.
[6] Roelants F,Lavand'homme P.Clonidine versus sufentanil as an adju-vant to ropivacaine in patient-controlled epidural labour analgesia: A randomised double-blind trial[J].Eur J Anaesthesiol,2015,32(11):805-811.
[7] Siddiqui KM,Ali MA,Ullah H.Comparison of spinal anesthesia dosage based on height and weight versus height alone in patients undergoing elective cesarean section[J].Korean J Anesthesiol,2016,69(2):143-148.
[8] 唐勇,徐骏,贾飞,等.罗哌卡因与左旋布比卡因复合舒芬太尼用于分娩镇痛效果比较[J].中国药业,2014,23(17):116-117.
[9] 赵志强.舒芬太尼联合甲磺酸罗哌卡因对剖宫产手术产妇免疫功能、血流动力学和应激反应指标的影响[J].贵州医药,2017,41(5):490-492.
[10] Keplinger M,Marhofer P,Kettner SC,et al.A pharmacodynamic evaluation of dexmedetomidine as an additive drug to ropivacaine for peripheral nerve blockade:A randomised,triple-blind,controlled study in volunteers[J].Eur J Anaesthesiol,2015,32(11):790-796.
[11] 余奇劲.两种蛛网膜下腔阻滞麻醉方案在高龄产妇剖宫产手术中的应用效果比较[J].广西医学,2018,40(1):51-54.
[12] 徐红州,郝继英,黄东华,等.不同药物复合罗哌卡因蛛网膜下腔阻滞用于分娩镇痛效果比较[J].医药导报,2017,36(5):517-520.
[13] 李冰,陈绪军,郭艳,等.不同浓度罗哌卡因复合舒芬太尼在硬膜外阶梯式分娩镇痛中的应用[J].临床麻醉学杂志,2016,32(4):361-365.
[14] 王倩,高宇,幸志强.妊娠期糖尿病产妇剖宫产术后联合使用舒芬太尼硬膜外镇痛疗效观察[J].世界临床药物,2016,37(7):474-477,S18.
[15] 王言武,孙岸灵.多模式镇痛对下肢骨折患者术后疼痛、炎性因子及免疫功能的影响[J].安徽医药,2015,19(5):974-977.
[16] 赵清振,严海雅.盐酸罗哌卡因椎管内麻醉对剖宫产术HIV感染者细胞免疫功能的影响[J].中国妇幼保健,2017,32(16):3978-3980.
[2] Hamilton BE,Martin JA,Ventura SJ.Births:preliminary data for 2012[J].Natl Vital Stat Rep,2013,62(3):1-20.
[3] 邓超,吴畏.右美托咪定对全麻剖宫产患者血流动力学及应激反应的影响[J].四川医学,2015,36(2):191-194.
[4] 梁淑敏,林颖,唐貌.利多卡因联合芬太尼在剖宫产手术硬膜外麻醉中的效果研究[J].中国计划生育和妇产科,2014,6(9):64-66.
[5] 阮北燕,陈清娟,陈健,等.不同剂量舒芬太尼与罗哌卡因复合硬膜外麻醉在剖宫产术中的应用[J].中国现代医生,2018,56(1):107-110.
[6] Roelants F,Lavand'homme P.Clonidine versus sufentanil as an adju-vant to ropivacaine in patient-controlled epidural labour analgesia: A randomised double-blind trial[J].Eur J Anaesthesiol,2015,32(11):805-811.
[7] Siddiqui KM,Ali MA,Ullah H.Comparison of spinal anesthesia dosage based on height and weight versus height alone in patients undergoing elective cesarean section[J].Korean J Anesthesiol,2016,69(2):143-148.
[8] 唐勇,徐骏,贾飞,等.罗哌卡因与左旋布比卡因复合舒芬太尼用于分娩镇痛效果比较[J].中国药业,2014,23(17):116-117.
[9] 赵志强.舒芬太尼联合甲磺酸罗哌卡因对剖宫产手术产妇免疫功能、血流动力学和应激反应指标的影响[J].贵州医药,2017,41(5):490-492.
[10] Keplinger M,Marhofer P,Kettner SC,et al.A pharmacodynamic evaluation of dexmedetomidine as an additive drug to ropivacaine for peripheral nerve blockade:A randomised,triple-blind,controlled study in volunteers[J].Eur J Anaesthesiol,2015,32(11):790-796.
[11] 余奇劲.两种蛛网膜下腔阻滞麻醉方案在高龄产妇剖宫产手术中的应用效果比较[J].广西医学,2018,40(1):51-54.
[12] 徐红州,郝继英,黄东华,等.不同药物复合罗哌卡因蛛网膜下腔阻滞用于分娩镇痛效果比较[J].医药导报,2017,36(5):517-520.
[13] 李冰,陈绪军,郭艳,等.不同浓度罗哌卡因复合舒芬太尼在硬膜外阶梯式分娩镇痛中的应用[J].临床麻醉学杂志,2016,32(4):361-365.
[14] 王倩,高宇,幸志强.妊娠期糖尿病产妇剖宫产术后联合使用舒芬太尼硬膜外镇痛疗效观察[J].世界临床药物,2016,37(7):474-477,S18.
[15] 王言武,孙岸灵.多模式镇痛对下肢骨折患者术后疼痛、炎性因子及免疫功能的影响[J].安徽医药,2015,19(5):974-977.
[16] 赵清振,严海雅.盐酸罗哌卡因椎管内麻醉对剖宫产术HIV感染者细胞免疫功能的影响[J].中国妇幼保健,2017,32(16):3978-3980.