产妇产程潜伏期罗哌卡因混合舒芬太尼硬膜外分娩镇痛的效果

Effects of epidural ropivacaine and sufentanil during latent phase of labor in nulliparous women

目的观察产妇产程潜伏期和活跃期罗哌卡因混合舒芬太尼硬膜外分娩镇痛的效应, 评价潜伏期镇痛的可行性。方法 120例无产科及硬膜外阻滞禁忌症的单胎孕初产妇,随机分为2 组。潜伏期组(L组):当进入产程、但宫口<3 cm进行镇痛;活跃期组(A组):当宫口≥3 cm进行镇痛。硬膜外穿刺成功后,两组分别单次给予0．1％、O．15％罗哌卡因与O．5μg/ml 舒芬太尼混合液10- 15 ml。30 min后行硬膜外自控镇痛,药物为0．1％罗哌卡因和0．5 μg/ml舒芬太尼的混合液,PCA量6 ml,锁定时间20 min(L组)、15 min(A组)。行VAS评分和运动神经阻滞分级,记录产后产妇的不良反应,对新生儿行Apgar评分。结果两组镇痛后VAS评分均降低,与A组比较,L组镇痛前VAS评分降低,镇痛后20、30 min VAS评分升高,下肢麻木发生率升高,镇痛前催产素使用率及镇痛后催产素追加率降低(P<0．05)。两组产程、剖宫产率和器械助产率及镇痛满意度的优良率差异无统计学意义 (均超过95％)(P>0．05)。结论产妇产程潜伏期0．1％罗哌卡因混合O．5μg/ml舒芬太尼硬膜外分娩镇痛安全、有效。

Objective To evaluate the efficacy of PCEA with ropivacaine and sufentanil in nulliparous women presenting in latent versus active phase of spontaneous labor.Methods One hundred and twenty nulliporous ASA physical status Ⅰ or Ⅱ women at 〉 36 week of gestation who requested labor analgesia were assigned to one of two groups according to cervical dilation （ n = 60 each） ： latent group （ cervical dilation 〈 3 cm） and active group （cervical dilation3 cm）. Both groups received a loading dose of 10-15 ml of PECA solution of 0.1% （ latent group） or 0.15 % ropivacaine （ active group） and sufentanil 0.5 μg·ml^-1. The PCEA pump was programmed to deliver a bolus dose of 6 ml of PCEA solution of 0.1% ropivacaine and sufentanil 0.5 μg·ml^-1 with a lockout interval of 20 min in latent group or 15 rain in active group. The intensity of pain was evaluated using VAS. Motor block was assessed using Bromage scale. The maternal vital signs, the side effects and the Apgar score of the newborn were also recorded. Results The two groups were comparable in regard to age, height, body weight and weeks of gestation. VAS scores （0 = no pain, 10 = worst pain） were higher in active group than in latent group before epidural analgesia and were significantly reduced after loading dose in both groups. Parturients in active group had lower VAS scores at 20 and 30 min after epidural loading dose than those in latent group. More parturients in active group had feeling of lower limb numbness. Oxytocin consumption was significantly higher before and during analgesia in latent group. There were no significant differences in the length of labor, incidence of Cesarean section or instrumental delivery and Apgar scores between the two groups. Patient satisfaction was equally high in both groups. Conclusion PCEA with 0.1% ropivacaine plus sufentanil 0.5 μg·ml^-1 provides excellent analgesia with minimal adverse effect for patients in latent phase of labor.