蛛网膜下腔注射芬太尼对剖宫产产妇寒战影响.docVIP

蛛网膜下腔注射芬太尼对剖宫产产妇寒战影响【摘要】 目的 研究蛛网膜下腔注射芬太尼对剖宫产产妇寒战的影响。方法 剖宫产产妇100例，随机等分为Ⅰ组（实验组）和Ⅱ组（对照组）。选用蛛网膜下腔阻滞麻醉-硬膜外联合麻醉，于L2～3椎间隙蛛网膜下腔注入蛛网膜下腔阻滞麻醉液2．4 ml，Ⅰ组蛛网膜下腔阻滞麻醉液含芬太尼20 μg。记录阻滞平面、血压（Bp）、心率（HR），观察患者寒战发生情况。结果 寒战发生例数Ⅰ组12例，明显低于Ⅱ组30例（P＜0．01）；轻度寒战Ⅰ组8例，Ⅱ组19例；重度寒战Ⅰ组4例，Ⅱ组11例。Ⅰ组明显低于Ⅱ组（P＜0．01）；胎儿娩出前出现寒战者Ⅰ组4例，明显少于Ⅱ组13例（P＜0．01）。结论 蛛网膜下腔注射芬太尼可降低剖宫产产妇胎儿娩出前寒战发生率及总发生率。 【关键词】 寒战；芬太尼；蛛网膜下腔阻滞；剖宫产 Effects of intrathecal fentanyl on shivering in parturients during in cesarean section．LIANG Wei．Department of Anesthsiology，Maternal and Children Health Care Hospital of Guangxi,Yulin 537000,China 【Abstract】 Objective To determine the effects of intrathecal fentanyl on shivering duringcesarean section for spinal anaesthesia．Methods Parturients undergoing cesarean section were randomly allocated into group Ⅰ and group Ⅱ．GroupⅠreceived levobupivacaine 7．5 mg with 20 μg of fentanyl and 10% glucose liquor to a total amount of 2．4 ml．GroupⅡreceived 0．5% levobupivacaine 2．4 ml for spinal anesthesia，Bp，HR and sedation scorewere recorded．Shivering was evaluated for a period of 1 hour．Results There was no significant difference between two groups in blocked level，Bp，HR and sedation score．12 parturients in group Ⅰshivering compared with 30 parturient in group Ⅱ(P＜0．05)．4 parturients with severe shivering were seen in group Ⅰ and 11 in group Ⅱ(P＜0．01)．Group Ⅰ was obviously lower than group Ⅱ, when 13 parturients in group Ⅱ developed shivering before fetal birth compared with 4 in group Ⅰ(P＜0．01)．Conclusion Intrathecal fentanyl reduces shivering in parturients undergoing cesarean section,especially before fetal birth． 【Key words】 Shivering；Fentanyl；Spinal anaesthesia；Cesarean section 剖宫产术多采用硬膜外麻醉、蛛网膜下腔阻滞和蛛网膜下腔阻滞麻醉-硬膜外联合麻醉3种椎管内麻醉方法。椎管内麻醉后为体内热能从深部向外周再分布，因此剖宫产产妇寒战发生率高。本文研究蛛网膜下腔注射芬太尼对剖宫产产妇寒战的影响。 1 资料与方法 1．1 一般资料 本组拟行剖宫产手术产妇100例，ASAⅠ～Ⅱ级，随机等分为Ⅰ组（实验组）和Ⅱ组（对照组），每组50例，两组患者年龄、体质量、手术时间差异无统计学意义。排除低血压以及输液反应引起的寒战患者。 1．2 方法 术前未用阿托品和苯巴比妥钠。入室后持续监测ECG、Bp、HR、SpO2。建立静脉通道，常规面罩吸氧3 L/min，术中输注平衡液15 ml/kg，以10 ml/(kgh)