异丙酚-氟哌利多用于预防舒芬太尼鞘内注射所致瘙痒临床探究.docVIP

异丙酚\氟哌利多用于预防舒芬太尼鞘内注射所致瘙痒临床探究【摘要】 目的 比较小剂量氟哌利多和亚催眠剂量的异丙酚对舒芬太尼鞘内注射所导致的瘙痒的预防和治疗作用,以寻求减少阿片类药物鞘内注射所致瘙痒发生率的有效方法。方法 ASAⅠ~Ⅱ级,拟行剖宫产手术的适龄产妇180例,随机分为I组(异丙酚组),II组(氟哌啶组)和III组(对照组)每组60例。于 L3~4穿刺,注入0.5%罗哌卡因1.5 ml,舒芬太尼5 μg(5 μg/ml)和0.9%氯化钠注射液1 ml的混合药液3 ml,腰麻下完成剖宫产手术,待胎儿娩出后,I组(异丙酚组)产妇静脉给予异丙酚0.35 mg/kg,II组(氟哌啶组)给予氟哌啶0.021 mg/kg,III组(对照组)给予生理盐水2 ml。观察并记录患者术后瘙痒和其他不良反应的反生情况。结果 I组(异丙酚组),II组(氟哌啶组)中度以上瘙痒的发生率明显低于III组(对照组)。其中,氟哌啶的NNT值为3.52,95%CI:3.37~3.67。异丙酚的NNT值为4.61,95%CI:4.45~4.77。结论 氟哌啶和异丙酚可以有效地减少阿片类药物鞘内注射所引起的瘙痒。 【关键词】 舒芬太尼;瘙痒;阿片类药物 Study of the prophylactic effect of droperidol and propofol on spinal Sufentanil-induced pruritus ZHAO Shu-fang,YAN Jun-lian,ZHANG Lei,et al.Department of Anesthesiology,Sixth People’s Hospital of Zhengzhou City, Henan Province 450005,China 【Abstract】 Objective Tocompared the use of propofol and droperidol for the prevention of spinal Sufentanil-induced pruritus.Methods One hundred and eighty ASA I-II women undergoing Caesarean section under spinal anaesthesia,in which Sufentanil 5 μg was added to a local anaesthetic,were assigned randomly to receive intravenous,in the operating room,just after delivery of the baby,propofol 0.35 mg/kg,droperidol 0.021 mg/kg or saline 2 ml(control group).In the postoperative period,the women were assessed for pruritus(absent,mild,moderate or severe)or other untoward symptoms.Results The droperidol,propofol groups had significantly lower incidences of pruritus compared with the control group.As for the prevention of moderate and severe pruritus,droperidol had the lowest NNT(3.52;95%CI:3.37-3.67),followed by propofol(4.61;95%CI:4.45-4.77).Conclusion Droperidol,propofol in a decreasing order of effectiveness in the doses used in this study,reduced the incidence of pruritus induced by the use of Sufentanil 5 μg intrathecally. 【Key words】 Analgesics opioid;Pruritus;Sufentanil 剖宫产手术是产科最常见的手术之一,而椎管内麻醉则是剖宫产手术常选的麻醉方式,随着产科横切口的增加,腰麻的使用越来越多,而鞘内注射阿片类药物可以发挥与局麻药的协同作用,增强其镇痛效应[1],从而减少局麻药的用量,因此,临床上常将局麻药复合小剂量阿片类药物(如吗啡、芬太尼等)