咪唑安定复合芬太尼与罗哌卡因行产科麻醉效果的对比分析(1)
[摘要] 目的 对比分析咪唑安定复合芬太尼与罗哌卡因行产科麻醉的效果。 方法 选取我院2014年4月～2015年10月期间收治的产科择期手术患者172例，采用随机数字法将所收治患者分为观察组和对照组，每组86例。对照组患者给予咪唑安定复合芬太尼进行麻醉，观察组患者给予罗哌卡因进行麻醉。对比两组患者术中不同时段的心率(HR)、平均动脉压(mean artery pressure，MAP)、血氧饱和度(saturation of oxygen，SaO2)、OAA/S的评估分数和术后不同时段的镇痛评分(VAS)以及不良反应发生情况。 结果 观察组患者术中20 min、40 min、60 min 的心率、平均动脉压、血氧饱和度、OAA/S评分、术后各时段的VAS评分与对照组相比，差异均具有统计学意义(P<0.05)；观察组术后不良反应发生率低于对照组，差异具有统计学意义(P<0.05)。 结论 罗哌卡因在产科手术麻醉中安全性更高，镇痛、镇静效果更好，术后不良反应发生率更少，相比咪唑安定复合芬太尼更值得推广使用。
[关键词] 咪唑安定；芬太尼；罗哌卡因；产科麻醉
[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701(2017)22-0096-04
[Abstract] Objective To compare the effects of midazolam combined with fentanyl and ropivacaine on obstetric anesthesia. Methods A total of 172 patients receiving obstetric elective surgery were selected in our hospital from April 2014 to October 2015 as the study subjects. The patients were divided into the observation group and the control group by random number method， with 86 patients in each group. Patients in the control group were given anesthesia with midazolam combined with fentanyl； patients in the observation group were given ropivacaine for anesthesia. Scores of evaluation of heart rate(HR)， mean arterial pressure(MAP)， saturation of oxygen(SaO2)， OAA/S at different time points during the surgery were compared between the two groups， and the scores of pain(VAS) and the incidence of adverse reactions were compared at different time points after the surgery. Results The heart rate， mean arterial pressure， oxygen saturation， OAA/S scores at 20 min， 40 min and 60 min during the surgery and VAS scores at different time points after the surgery in the observation group were compared with those in the control group， and the differences were all statistically significant(P<0.05)； the incidence of postoperative adverse reactions in the observation group was lower than that in the control group， and the difference was statistically significant(P<0.05). Conclusion Ropivacaine has a higher safety in obstetric anesthesia， with better effects of analgesia and sedation， and lower incidence of postoperative adverse reactions， which is more worthy of popularization and application compared with midazolam combined with fentanyl.
[Key words] Midazolam； Fentanyl； Ropivacaine； Obstetric anesthesia
剖宫产术、子宫切除术及附件切除术均为妇产科开展较广泛的手术[1]。剖宫产术主要用于各类异常分娩，因分娩时的剧痛所导致的体内神经-内分泌系统改变易对产妇及胎儿造成较大危害，故剖宫产术的麻醉镇痛对于分娩成功具有重大意义[2]。子宫肿瘤或子宫出血常需采用子宫切除术治疗，附件切除术多用于保守治疗无效的卵巢子宫内膜异位或附件炎症，两种手术因对患者创伤较大，故亦对麻醉镇痛药物有着较高的要求[3]。咪唑安定又称咪达唑仑，属于经典的苯二氮类药物，多用于术前镇静。芬太尼属于强效阿片类受体激动剂，为强效麻醉镇痛药物，通常与安定类药物配伍用于妇产科手术麻醉，效果较显著[4]。罗哌卡因作为一种新型麻醉镇痛药物，已受到临床广泛关注，根据相关文献报道其麻醉效果優于咪唑安定复合芬太尼[5]。本研究拟对两种药物在产科手术中的麻醉效果进行对比，旨在为临床实践提供指导。现报道如下。, 百拇医药(胡琼 严海雅)
[关键词] 咪唑安定；芬太尼；罗哌卡因；产科麻醉
[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701(2017)22-0096-04
[Abstract] Objective To compare the effects of midazolam combined with fentanyl and ropivacaine on obstetric anesthesia. Methods A total of 172 patients receiving obstetric elective surgery were selected in our hospital from April 2014 to October 2015 as the study subjects. The patients were divided into the observation group and the control group by random number method， with 86 patients in each group. Patients in the control group were given anesthesia with midazolam combined with fentanyl； patients in the observation group were given ropivacaine for anesthesia. Scores of evaluation of heart rate(HR)， mean arterial pressure(MAP)， saturation of oxygen(SaO2)， OAA/S at different time points during the surgery were compared between the two groups， and the scores of pain(VAS) and the incidence of adverse reactions were compared at different time points after the surgery. Results The heart rate， mean arterial pressure， oxygen saturation， OAA/S scores at 20 min， 40 min and 60 min during the surgery and VAS scores at different time points after the surgery in the observation group were compared with those in the control group， and the differences were all statistically significant(P<0.05)； the incidence of postoperative adverse reactions in the observation group was lower than that in the control group， and the difference was statistically significant(P<0.05). Conclusion Ropivacaine has a higher safety in obstetric anesthesia， with better effects of analgesia and sedation， and lower incidence of postoperative adverse reactions， which is more worthy of popularization and application compared with midazolam combined with fentanyl.
[Key words] Midazolam； Fentanyl； Ropivacaine； Obstetric anesthesia
剖宫产术、子宫切除术及附件切除术均为妇产科开展较广泛的手术[1]。剖宫产术主要用于各类异常分娩，因分娩时的剧痛所导致的体内神经-内分泌系统改变易对产妇及胎儿造成较大危害，故剖宫产术的麻醉镇痛对于分娩成功具有重大意义[2]。子宫肿瘤或子宫出血常需采用子宫切除术治疗，附件切除术多用于保守治疗无效的卵巢子宫内膜异位或附件炎症，两种手术因对患者创伤较大，故亦对麻醉镇痛药物有着较高的要求[3]。咪唑安定又称咪达唑仑，属于经典的苯二氮类药物，多用于术前镇静。芬太尼属于强效阿片类受体激动剂，为强效麻醉镇痛药物，通常与安定类药物配伍用于妇产科手术麻醉，效果较显著[4]。罗哌卡因作为一种新型麻醉镇痛药物，已受到临床广泛关注，根据相关文献报道其麻醉效果優于咪唑安定复合芬太尼[5]。本研究拟对两种药物在产科手术中的麻醉效果进行对比，旨在为临床实践提供指导。现报道如下。, 百拇医药(胡琼 严海雅)