阿芬太尼对腰-硬联合麻醉剖宫产术中牵拉痛及寒战的影响

郜宗斌; 杨光; 施舟; 胡军; 王萍

doi:10.16766/j.cnki.issn.1674-4152.003244

阿芬太尼对腰-硬联合麻醉剖宫产术中牵拉痛及寒战的影响

doi: 10.16766/j.cnki.issn.1674-4152.003244

郜宗斌¹,
杨光¹,
施舟¹,
胡军²,
王萍^1, ,

1.
铜陵市人民医院麻醉科，安徽铜陵 244000
2.
安徽医科大学第一附属医院疼痛科，安徽合肥 230022

基金项目:

国家自然科学基金项目 81901086

详细信息

通讯作者:
王萍，E-mail: wangpingd@139.com

中图分类号: R614.42R719.82
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- 文章访问数: 158
- HTML全文浏览量: 79
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2023-04-23
- 网络出版日期: 2024-01-13

Effects of alfentanil on traction pain and shivering during combined spina-epidural anesthesial for cesarean section

1.
Department of Anesthesiology, Tongling People's Hospital, Tongling, Anhui 244000, China

摘要

摘要: 目的观察阿芬太尼对腰硬联合麻醉下行剖宫产术的产妇术中牵拉痛和寒战的防治效果，为临床提供参考。方法选择铜陵市人民医院2022年1—12月在腰硬联合麻醉下行剖宫产的产妇共62例，采用随机数字表分为阿芬太尼组(A组)和对照组(C组)，每组各31例。2组产妇均进行腰硬联合麻醉，麻醉后调整麻醉感觉平面至T_6~8，A组胎儿娩出夹闭脐带后，静脉注射阿芬太尼3.0 μg/kg，随后持续静脉泵入阿芬太尼0.125 μg/(kg·min)至术毕，C组胎儿娩出夹闭脐带后给予等剂量生理盐水至术毕。记录2组产妇一般情况，术中牵拉痛发生情况，寒战、恶心、呕吐、皮肤瘙痒及低氧血症的发生率，各时间点产妇的平均动脉压(MAP)、心率(HR)。结果 2组产妇一般情况比较差异无统计学意义(均P＞0.05), 2组牵拉痛发生率[22.58%(7/31) vs.56.67%(17/30)]差异有统计学意义(P＜0.05)，A组无中重度牵拉痛，且A组寒战(6.5%, 2/31)的发生率明显低于C组(33.3%, 10/30，χ²=6.972，P＜0.05)。2组产妇皮肤瘙痒和恶心、呕吐的发生率比较差异无统计学意义(均P＞0.05)。2组产妇组间各时间点MAP、HR差异无统计学意义(MAP：F_组间=0.142，P=0.708；HR：F_组间=0.006，P=0.937)，组内不同时间点差异有统计学意义(MAP：F_时间=24.434，P＜0.001；HR：F_时间=11.045，P＜0.001)，组别与时间不存在交互作用(MAP：F_交互=1.107，P=0.355；HR：F_交互=0.616，P=0.659)。结论阿芬太尼可有效预防腰硬联合麻醉剖宫产产妇牵拉反应及寒战的发生。
- 阿芬太尼 /
- 剖宫产 /
- 腰硬联合麻醉 /
- 牵拉痛 /
- 寒战
Abstract: Objective To investigate the effect of alfentanil on the prevention of traction pain and shivering in puerperae during combined spina/epidural anesthesia (CSEA) cesarean section, to provide a reference for clinical work. Methods A total of 62 parturients who underwent cesarean section under combined spinal-epidural anesthesia at Tongling People's Hospital from January to December 2022 were selected and randomly divided into two groups using a random number table: alfentanil group (group A) and control group (group C), 31 cases per group. After anesthesia, the level of anesthesia sensation was adjusted to T_6-8.After delivery of the umbilical cord, alfentanil 3 μg/kg was injected intravenously, then continuous intravenous infusion alfentanil at 0.125 μg/(kg·min); Group C puerperae were given the same dose of normal saline after delivery of the umbilical cord clamping until the end of the operation. We recorded the general situation, intraoperative traction pain, shivering, skin itching, nausea, vomiting and meionectic blood rates in the groups, mean arterial pressure (MAP) and heart rate (HR) of puerperaeat at each time point. Results There was no significant difference in general condition between the two groups of parturients (P > 0.05), There was a significant difference in the incidence of traction pain between the two groups [22.58%(7/31) vs. 56.67%(17/30), P < 0.05]. Group A had no moderate to severe traction pain, and the incidence of tremor in Group A (6.5%, 2/31) was significantly lower than that in Group C (33.3%, 10/30, χ²=6.972, P < 0.05). There was no significant difference in the incidence of pruritus, nausea, and vomiting between the two groups of parturients (P > 0.05). There was no significant difference in MAP and HR at different time points between the two groups of parturients (MAP: F_interblock=0.142, P=0.708; HR: F_interblock=0.006, P=0.937), there was a statistically significant difference at different time points within the group (MAP: F_time=24.434, P < 0.001;HR: F_time=11.045, P < 0.001), and there was no interaction between the group and time (MAP: F_interaction=1.107, P=0.355; HR: F_interaction=0.616, P=0.659). Conclusion Alfentanil can effectively prevent traction reaction and shivering in cesarean section under CSEA.
- Alfentanil /
- Cesarean section /
- Combined spina/epidural anesthesia /
- Traction pain /
- Shivering

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表 1 2组产妇一般情况的比较

Table 1. Comparison of the general situation between two groups of parturients

组别	例数	年龄(x±s，岁)	孕周(x±s，d)	ASA分级(Ⅰ/Ⅱ，例)	BMI (x±s)	输液量[M(P₂₅, P₇₅), mL]	出血量[M(P₂₅, P₇₅), mL]	手术时间(x±s，min)
A组	31	30.42±4.50	269.58±7.65	21/10	27.33±3.03	800(700，900)	350(300，400)	64.68±15.97
C组	30	30.90±4.12	271.03±8.42	13/17	27.35±2.43	825(700，900)	350(300，400)	66.00±16.37
统计量		0.432^a	0.705^a	3.682^b	0.028^a	0.810^c	0.237^c	0.320^a
P值		0.668	0.483	0.055	0.978	0.180	0.812	0.751
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 2组产妇术中MAP变化比较(x±s, mmHg)

Table 2. Comparison of intraoperative MAP changes between two groups of parturients (x±s, mmHg)

组别	例数	T0	T1	T2	T3	T4	T5	T6	F值	P值
A组	31	93.07±7.16	83.71±8.58^a	78.23±8.69^a	77.45±9.45^a	76.19±8.93^ab	75.84±7.10^ab	78.90±8.19^a	13.737	＜0.001
C组	30	90.16±9.24	80.36±18.17	79.32±11.35^a	74.92±8.02^a	76.04±9.16^a	77.00±7.75^a	81.52±9.55^ac	9.035	＜0.001
t值		1.326	0.910	0.409	1.065	0.063	0.588	1.103
P值		0.190	0.367	0.684	0.291	0.950	0.559	0.275
注：与同组T0比较，^aP＜0.05；与同组T1比较，^bP＜0.05；与同组T3比较，^cP＜0.05。1 mmHg=0.133 kPa。

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表 3 2组产妇术中HR变化比较(x±s, 次/min)

Table 3. Comparison of intraoperative HR changes between two groups of parturients (x±s, times/min)

组别	例数	T0	T1	T2	T3	T4	T5	T6	F值	P值
A组	31	91.48±11.52	90.26±14.27	87.32±13.12	86.45±13.11	84.87±12.81^ab	85.19±11.93^a	81.58±10.64^abc	6.200	＜0.001
C组	30	89.59±12.60	90.04±14.17	88.41±13.45	86.93±13.03	87.63±14.76	84.52±13.95	81.70±13.60^acde	3.981	0.008
t值		0.597	0.059	0.310	0.138	0.762	0.199	0.039
P值		0.553	0.953	0.757	0.891	0.449	0.843	0.969
注：与同组T0比较，^aP＜0.05；与同组T1比较，^bP＜0.05；与同组T2比较，^cP＜0.05；与同组T3比较，^dP＜0.05；与同组T4比较，^eP＜0.05。

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表 4 2组产妇牵拉痛分级比较[例(%)]

Table 4. Comparison of traction pain grading between two groups of parturients [cases (%)]

组别	例数	无疼痛	轻度	中度	重度	疼痛总体发生
A组	31	24(77.42)	7(22.58)	0	0	7(22.58)
C组	30	13(43.33)	12(40.00)	3(10.00)	2(6.67)	17(56.67)
统计量		-4.841^a				7.423^b
P值		＜0.001				0.006
注：^a为Z值，^b为χ²值。

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表 5 2组产妇不良反应发生情况比较[例(%)]

Table 5. Comparison of adverse reactions between two groups of parturients [cases (%)]

组别	例数	恶心呕吐	寒战	瘙痒	低氧血症
A组	31	3(9.7)	2(6.5)	0	0
C组	30	8(26.7)	10(33.3)	1(3.3)	0
χ²值		2.977	6.972	1.051
P值		0.084	0.008	0.492

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