比较芬太尼与哌替啶预处理防治子宫下段剖宫产术中寒战的效果

林晓莲 叶敏涛 杨泽萍

【摘要】目的：比较芬太尼与哌替啶预处理预防子宫下段剖宫产术中胎儿娩出后寒战的效果。方法：选择2017年8月至2020年8月在我院择期行腰硬联合麻醉下子宫下段剖宫产术产妇60例，采用随机数字表法分为芬太尼组（F组）和哌替啶组（P组），每组30例。两组产妇在术中胎儿娩出后，分别静脉注射相应药物，F组缓慢注射芬太尼20μg，P组患者则缓慢注射哌替啶20mg。记录两组产妇给药前5min、给药后10min、给药后30min Ramsay镇静评分；记录两组产妇寒战发生情况和牵拉痛评分；记录两组产妇用药后出现的不良反应。结果：F组产妇在给药后10min、给药后30min Ramsay镇静评分明显高于P组（P<0.05）；两组产妇寒战发生率和牵拉痛评分比较无明显差异（P>0.05）。结论：芬太尼防治子宫下段剖宫产术中胎儿娩出后寒战的效果与哌替啶相当，且能为产妇提供一定程度镇静，提高舒适度。

【关键词】芬太尼；哌替啶；子宫下段剖宫产术；寒战

[中图分类号]R719.8； R614 [文献标识码]A [文章编号]2096-5249（2021）05-0074-03

Effect of fentanyl and pethidine pretreatment in the prevention and treatment of shivering in lower uterine cesarean section

LIN Xiao-lian， YE Min-tao， YANG Ze-ping （Department of Anesthesiology， Jiedong maternal and child health hospital， Jieyang Guangdong522000， China）

[Abstract] Objective： To compare the effect of fentanyl and pethidine pretreatment in the prevention and treatment of shivering in lower uterine cesarean section. Methods： From August 2017 to August 2020， 60 pregnant women undergoing lower uterine cesarean section under combined spinal and epidural anesthesia were randomly divided into fentanyl group （Group F） and pethidine group （Group P）， with 30 cases in each group. After the delivery of the fetus in the two groups， fentanyl 20 μg was injected intravenously in group F and pethidine 20 mg in group P. The Ramsay Sedation score at different time points of the two groups were recorded. The occurrence of shivering and traction pain score in two groups were recorded. The adverse reactionsin two groups after medication were recorded. Results： The Ramsay Sedation score of group F was significantly higher than that of group P at 10 min and 30 min after administration（P<0.05）. There was no significant difference in the incidence of shivering and traction pain score between the two groups（P>0.05）. Conclusion： Fentanyl has the same effect as pethidine in the prevention and treatment of shivering after delivery of fetus in lower uterine segment cesarean section， and it can provide a certain degree of sedation and improve comfort for puerpera.

[Key word] Fentanyl； Pethidine； Lower uterine cesarean section； Shivering

寒戰是麻醉常见并发症，在子宫下段剖宫产术中最常见。寒战的临床表现主要是嘴唇或肢体出现无法控制的不自主颤抖，增加机体氧耗，给机体造成一定不良影响，影响患者麻醉手术体验，增加患者心理负担，给舒适医疗带来严峻挑战[1-4]。多项临床研究表明，寒战可发生在剖宫产术中任意时间段，但绝大多数发生在胎儿娩出后，临床上多采用药物治疗来防治剖宫产术中寒战，右美托咪定、布托啡诺、曲马多等药物均能有效预防剖宫产术中寒战，各种药物防治效果均有差异[5-8]。……