| Objective: Spinal anesthesia is the main anesthesia mode of clinical cesarean section.However,cesarean section under spinal anesthesia is similar to many other spinal anesthesia operations,which have many deficiencies,mainly various adverse reactions and hemodynamic disorders caused by drugs for spinal anesthesia;in addition,cesarean section under spinal anesthesia also causes different degrees of motion recovery delay,and then has some influence on the recovery of the women after operation.Therefore,to strengthen the research on adverse reactions of anesthesia in cesarean section has become one of the main research directions of anesthesiologists.At present,a large number of clinical studies have found that the maximum dose range of sufentanil given by epidural is 10~20ug,but there is still no agreement on the optimum analgesic dose effect relationship of sufentanil.In this paper,the results of anesthesia and postoperative analgesia of cesarean section patients with the same dose of ropivacaine and different doses of sufentanil under combined spinal epidural anesthesia are analyzed and compared,to provide more reference for the optimum dose of sufentanil in cesarean section anesthesia.Method: Ninety cases of health,singleton and full-term expectant mothers,ASA Ⅰ ~ Ⅱ level to be scheduled for cesarean section in Yihe Obstetrics and Gynecology Branch,Cangzhou People’s Hospital were chosen.This study was approved by the medical ethics committee of our hospital and informed consent from all patients was received.The study data were divided into three groups according to the ratio of the same spinal anesthesia and different epidural drugs: 30 cases in each group.Group A: subarachnoid0.75% ropivacaine 2ml + 10% glucose 1ml(2.5ml injected);epiduralsufentanil 20 ug.Group B: subarachnoid 0.75% ropivacaine 2ml + 10%glucose 1ml(2.5ml injected);epidural sufentanil 15 ug.Group C: subarachnoid0.75% ropivacaine 2ml + 10% glucose 1ml(2.5ml injected);epidural sufentanil 10 ug.After the three groups of expectant mothers were pushed into the delivery room,the venous access was opened immediately,L2 ~ 3 gap was selected as the puncture point for the dural puncture with spinal anesthesia needle after entering the epidural space,and the needle core was pulled out after there was a sense of breakthrough;0.75% ropivacaine 2ml and 10%glucose 1ml was injected after clear cerebrospinal fluid flew back;after the spinal anesthesia needle was removed,different doses of sufentanil and 0.9%saline 5ml was pumped into the epidural space,and the epidural catheter was placed into.Then the patients were restored supine position,and the operation began after the patients’ pain disappeared.Observation index:1 Measurement of level of sensory block: The level of the pain sensory block was measured through acupuncture every 5 minutes;and every 1 minute within 5minutes after administration;then every 5 minutes until the skin incision.During the operation,the level of the loss of pain sensation was measured every 10 minutes.At the same time,the onset time of pain sensory block(time from the first injection to the loss of T8 plane pain sensation)as well as the upper bound of the level of pain sensory block(expressed in the spinal stage)were observed and recorded.2 The quality of postoperative analgesia was evaluated by visual analogue scale(VAS)for 2 hours,6 hours and 12 hours after operation.0points: maternal painless,10 severe pain.1~10 points,the degree of pain gradually increased.The biochemical parameters of 24 h venous blood were recorded before and after operation.3 The hemodynamic changes of the three groups were observed and recorded,and the ECG(electrocardiogram),BP(non-invasive blood pressure),HR(heart rate),RR(respiratory rate),SPO2(pulse oxygen saturation)of each group before anesthesia(T0),1 minute after anesthesia(T1),3 minutes afteranesthesia(T2),in skin incision(T3),at the time of the delivery of babies(T4),5 minutes after the delivery of babies(T5),when leaving(T6),2 hours after leaving(T7),and 6 hours after leaving(T8).4 Apgar scores 1 minute and 5 minutes after the delivery of babies as well as the incidence of nausea,vomiting,pruritus,urinary retention,chills and hypotension were observed.Result:1 There was a significant difference in the anesthetic effects of the three groups.The anesthesia effect of Group A and Group B was significantly better than that of Group C(P <0.05).2 There was no significant difference in pain VAS score between Group A and Group B(P> 0.05).However,the VAS score of Group A and Group B was significantly better than that of Group C and there was significant statistical difference(P <0.05).3 There was no significant difference in BP,HR,SPO2 between the three groups(P> 0.05)before the operation;and there was no significant difference in the SPO2 between the three groups(P> 0.05)after the operation;however,there was a significant difference in BP and HR between the three groups at each time point.Compared with Group C,the SBP of Group A and Group B decreased at T2,T3,and T7(P<0.05);the DBP of Group A decreased at T2,T3,T4 and T8(P<0.05);and the DBP of Group B decreased at T3,T4 and T8(P<0.05);The HR of Group A and Group B increased at T2,T3 and T7 but decreased at T8(P<0.05).Compared with T0 in SBP,the SBP of Group A decreased at T2,T3,T4 and T7(P<0.05),the SBP of Group B decreased at T2,T3,T4 and T8(P<0.05),and the SBP of Group C decreased at T2(P<0.05).Compared with T0 in DBP,the DBP of Group A decreased at T2,T3,T4,T5,T6,T7 and T8,the DBP of Group B decreased at T2,T3,T4,T6,T7 and T8,and the DBP of Group C decreased at T2,T3 and T4(P<0.05).Compared with T0 in HR,the HR of Group A,Group B and Group C increased at T2,T3 and T4 but decreased at T7 and T8(P<0.05).4 There was no significant difference in the motion recovery time,fetalApgar score and maximum motion block of each group(P> 0.05).5 Three groups of subjects,there were no neonatal asphyxia,hypoxemia,bradycardia and other serious adverse reactions;but there were mild nausea and vomiting,chills,itching,urinary retention,B group,C group and A group was statistically significant difference(P<0.05).Conclusion: Subarachnoid 0.75% ropivacaine 2ml + 10% glucose 1ml(2.5ml injected);epidural sufentanil 15 ug +% 0.9 normal saline diluted to 5ml can obtain the most satisfactory anesthesia and postoperative analgesic effect in cesarean section surgery;and can achieve an ideal balance between anesthetic effect and adverse reactions.Therefore,this anesthesia program is the optimum dose more suitable for clinical cesarean section anesthesia and postoperative analgesia. |
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