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鞘内吗啡对罗比卡因腰麻时剖宫产新生儿的影响及术后镇痛的评价

Effects of Intrathecal Morphine Injection on the Newborn Performed Hysterotokotomy during Lumbar Anesthesia by Ropivacaine and the Evaluation for Postoperative Analgesia

  • 摘要: 选择ASAⅠ~Ⅱ级足月妊娠产妇110例行剖宫产手术, 随机分成5组(各22例)实施腰麻: R对照组用w=0.68%的罗比卡因(Ropivacaine)2mL(13.5mg), RM1~RM4吗啡处理组, 分别于R组中加入吗啡0.1、0.2、0.3和0.4mg. 评价新生儿情况, 术后VAS和PHS镇痛评分, Ramasy镇静程度和围术期不良反应. 结果表明: 各组新生儿1min和5minApgar评分, 脐动脉血气值均在正常范围(P>0.05); 术后有效镇痛时间, R组不明显(3.6±2.7)h, RM1~RM4各组无痛时间≥12h, 其中RM2、RM3和RM4组>36h的病例数达60%以上. 术后各吗啡组皮肤瘙庠与剂量相关, 恶心呕吐增加不明显(P>0.05), 无呼吸抑制. 鞘内吗啡、罗比卡因能安全用于剖宫产术, 对新生儿无影响, 0.2~0.4mg吗啡鞘内注射术后镇痛效果良好.

     

    Abstract: 110 cases of full-term pregnancy parturients with ASA grade Ⅰ to Ⅱ were chosen as the objects to be performed cesarean section. They were randomly divided into 5 groups (each included 22 cases) for lumbar anesthesia. The experiment was adopted two arrangements:control group R (to which 2 mL Ropivacaine of w=0.68% (W/W) was used); morphine group RM1-RM4 (to which the morphine of 0.1 mg, 0.2 mg, 0.3 mg, 0.4 mg were respectively used on the base of group R). After that, the condition of newborn was evaluated, and the analgesia after operation was given a mark according to VAS and PHS, besides, the sedative degree of Ramasy and the harmfull reaction during cesarean section period were also investigation. The results showed that both the Apgar score and the value of umbilical artery's qi and blood at 1 or 5 min among each group of newborns are of normal (P>0.05); and for the time of effective analgesia after operation, there was not obvious in group R (3.6 h±2.7 h), but in group RM1 to RM4, painless time of each group was ≥ 12 h, and in group RM2, RM3, RM4, the number of illness cases that painless time was more than 36 h was over 60 percent. Whereas in each morphine group after operation, there was a correlation between cutaneous pruritus and dosage, but was not obvious aggravation in nausea and vomitus (P>0.05) and inhibition to respiration. Thus it was thought that both morphine and Ropivacaine could be safely used in cesarean section and had no effects on the newborn; meantime, the intrathecal injection used the morphine of 0.2 mg to 0.4 mg had a good effect on the postoperative analgesia.

     

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