目的：探讨盐酸左布比卡因与不同质量浓度枸橼酸舒芬太尼联合用于剖宫产术后自控硬膜外镇痛的疗效，为剖宫产术后镇痛枸橼酸舒芬太尼的用量选择提供参考。方法：选取佛山市三水区人民医院行剖宫产术的患者120例，以随机数字表法分为3组各40例。 A、B、C组患者术后分别给予0．15％盐酸左布比卡因与0．2、0．4、0．6μg／ml枸橼酸舒芬太尼进行自控镇痛处理。采用视觉模拟评分法对疼痛进行评价；所有患者术前2 h、术后24及48 h抽取静脉血，检测泌乳素水平；记录呼吸抑制、嗜睡、心动过缓、恶心呕吐等不良反应发生情况。结果：A组患者术后4、12、24、48 h疼痛评分均明显高于B、C组，镇痛失败率明显高于B、C组，差异均有统计学意义（P＜0．05），而B、C组的差异均无统计学意义（P＞0．05）。3组患者术后下肢肌力恢复较好，下肢阻滞评分均为0分。3组患者术前2 h血清泌乳素水平的差异无统计学意义（P＞0．05），术后24、48 h血清泌乳素水平均较术前2 h明显升高，且术后48 h高于术后24 h，差异均有统计学意义（P＜0．05）；A组患者术后24、48 h血清泌乳素水平均低于B、C组，差异有统计学意义（P＜0．05），而B、C组的差异无统计学意义（P＞0．05）。 A、B组出现呼吸抑制、嗜睡、恶心呕吐、低血压及心动过缓的病例数均少于 C 组，差异有统计学意义（ P＜0．05），而A、B 组的差异无统计学意义（ P＞0．05）。结论：盐酸左布比卡因与0．4μg／ml枸橼酸舒芬太尼联合用于剖宫产术后硬膜外镇痛的效果较好，且不良反应少，能使患者获得良好的泌乳素水平，是剖宫产术后镇痛的适宜选择。%OBJECTIVE:To evaluate the efficacy of different concentrations of sufentanil plus levobupivacaine for patient-controlled epidural analgesia in patients after undergoing caesarean section.METHODS:One hundred and twenty patients undergoing caesarean section were randomly assigned to three groups of 40 cases each and treated with levobupivacaine plus sufentanil ( group A:0.2 μg/ml, group B:0.4 μg/ml, group C:0.6 μg/ml ) .The pain was evaluated by visual analogue scales.Venous blood samples were taken from all the patients at 2 h before operation,and 24 and 48 hours after operation; the level of prolactin was detected, and the adverse reactions such as respiratory depression,drowsiness and tachycardia etc were recorded.RESULTS:The pain scores for group A at 4,12,24,48 hours after operation and the incidence of analgesia failure were signfciantly higher in group A than in group B or group C (P0.05).The muscle strength of the lower limbs of the 3 groups showed satisfactory recovery,and the lower limb blocking score was 0 point.There were no statistically significant differences among the three groups regarding serum prolactin level at 2 hours before operation ( P>0.05) ,which eleved significantly at 24 and 48 hours after operation,with higher level showing at 48 hours than at 24 hours,and the differences were all statistically significant(P0.05).Therewere more patients in group A and group B who presented with respiratory depression, sleepiness, nausea, vomiting, hypotension and bradycardia than in group C, and the differences were statistically significant ( P 0.05 ) .CONCLUSIONS:Levobupivacaine hydrochloride and sufentanil citrate(0.4 g/ml) used in combination for patient-controlled epidural analgesia in patients after undergoing cesarean section achieved satisfactory efficacy with few adverse drug reactions and satisfactory prolactin level obtained in patients,thus the combination therapy is an optimal choice for postoperative analgesia in patients after undergoing cesarean section.
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