| Objectives To explore the antalgic and sedative effect of sufentanil on the maternal and infant in caesarean section with epidural anesthesia and its placental transmission.Methods Sixty ASAⅡ healthy full-term mothers,who were taken cesarean section from March 2017 to July 2017,were randomly divided into two groups,as 30 cases of the control group A and 30 cases of the group B.HR,MAP,SpO2,ECG,VAS scores and Ramsay sedation scores were recorded at the time of entering the room(T0),beginning of the operation(T1),delivery of baby(T2)and closing the uterus(T3).The side effects(nausea,hypotension,bradycardia,respiratory depression)of puerpera,the time of delivery of the fetus(T1-2),the 1min,5min,10 min Apgar and 2h,24 h NBNA scores of newborn were monitored.In group B,puerperae were given 0.2μg/kg sufentanil through the peripheral vein at the beginning of the operation,the same volume 3ml of normal saline with the group A,at the fetal delivery of the umbilical cord ligation,3 ml of blood was extracted from the umbilical vein(UV)and umbilical arterial(UA),as well as maternal vein(MV)and dorsalis pedis artery(MA)seperately.All blood samples were taken as 1ml for blood gas analysis.The remaining 2ml was placed in a 3ml centrifuge tube(droped in 40μl of 50% sodium citrate in advance),5000 r/min centrifuged 10 min,drained the supernatant with a disposable plastic nozzle and place it into 2ml frozen storage tube,putted in a liquid nitrogen taken to be tested.Blank citrated plasma 1ml,with fentanyl 10μl(5ng/ml),was vortex-mixed for 1 min fully blended in group B.Then,3ml of acetonitrile was added to this mixture to be vortex-mixed for 15 min and centrifuged for 10 min at 3500r/min,fully extracted.After placed at room temperature for 5min,the upper organic phase was collected in a second 10 ml borosilicate glass tube and evaporated to dryness under a 2L/min stream of nitrogen at 40℃ water bath.Then the pipe wall was washed with 2 ml of acetonitrile,and repeated twice.The residue was dissolved in 100 μ l acetonitrile,ultrasonic oscillation 15 min after blending.The determination of sufentanil concentration was carried out,used the liquid chromatography-mass spectrometry(HPLC-MS)of 10μl.The blood concentration of sufentanil was obtained and the placental metastasis of sufentanil was calculated.Results 1 In group A,there was a statistical difference in T0~T3 VAS scores between four time points and the trend was rising(P <0.05),the VAS scores of T1,T2 and T3 in group A was significantly higher than that in group B(P <0.05),the VAS scores of group B was lower and the change was not remarkable at four points of times with no statistical significance(P > 0.05).The Ramsay scores of the two groups were of statistical significance(P <0.05),the scores of group B of T1,T2 and T3 were obvious higher than those of group A at the same time point,meanwhile the scores of group B was at the peak vulue(P <0.05).2 The blood concentrations of sufentanil in parent artery,maternal vein,umbilical vein and umbilical arterial were respectively measured(0.29±0.09)ng/ml,(0.29±0.07)ng/ml,(0.11±0.03)ng/ml,(0.07±0.02)ng/ml.The situation of placenta permeates were Cuv/Cmv:40.20% ± 2.66%,Cuv/Cma :39.91 ±2.68%,Cua/Cuv:61.21%±6.06%.About 40% of sufentanil was through the placental barrier and redistributed in the fetal body.However,the umbilical cord blood gas analysis,the 1min,5min,10 min Apgar scores and 2h,24 h NBNA scores in group B were both within the normal range,and the inhibition of neonatal respiration and circulatory were not found during the observation period.Conclusions 1 In this experiment,the epidural antalgic and sedative effect of sufentanil are obvious in maternal,but there are no obvious adverse effects on puerpera or neonates.The duration of observation and the number of samples are limited in the study,therefore it is essential to be cautious in intravenous auxiliary analgesia in cesarean section.2 The penetration rate of the placenta is Cuv/Cmv:40.20%±2.66%,Cuv/Cma:39.91±2.68%,Cua/Cuv:61.21%±6.06%. |
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