产妇分娩时舒芬太尼或芬太尼混合罗哌卡因病人自控硬膜外镇痛的效应

Sufentanil vs fentanyl in combination with ropivacaine for patient-controlled epidural analgesia during labor

目的比较产妇分娩时舒芬太尼或芬太尼混合罗哌卡因病人自控硬膜外镇痛(PCEA)的效应。方法无产科及硬膜外阻滞禁忌证的阴道分娩单胎初产妇120例,随机分为2组(n：60)：舒芬太尼混合罗哌卡因PCEA组(S组)和芬太尼混合罗哌卡因PCEA组(F组)。当产妇宫口开至3cm时,L_(2,3)间隙硬膜外穿刺置管,S组硬膜外注射0．15%罗哌卡因和0．5μg/ml舒芬太尼混合液试验剂量5 ml,随后追加上述混合液10 ml,30min后以0．1%哌卡因和0．5μg/ml舒芬太尼的混合液行PCEA；F组混合液中以2μg/ml芬太尼替代0．5μg/ml舒芬太尼,其他用药情况均与S组同。两组PCA剂量为6 ml,锁定时间为15 min。记录产妇视觉模拟疼痛评分(VAS)、下肢运动神经阻滞程度、生命体征、产程、分娩方式、不良反应及新生儿Apgar评分。结果两组镇痛期间VAS评分均降低,S组镇痛20～60 min VAS评分均低于F组。两组镇痛起效时间、达最高镇痛平面的时间、最高绝对平面、PCA实际按压次数、有效按压次数差异均无统计学意义。S组皮肤瘙痒的发生率高于F组,舒芬太尼、芬太尼用量分别为16±8、(70±28)μg,比率为1：4．4。两组产程和分娩方式构成比差异无统计学意义。结论产妇分娩时等效剂量的舒芬太尼或芬太尼混合罗哌卡因PCEA均可提供良好的镇痛效果。

Objective To compare the efficacy of sufentanil and fentanyl in combination with ropivacaine for patient controlled epidural analgesia （PCEA） during labor. Methods One-hundred and twenty nulliparous parturients in active labor （cervical dilatation = 3 cm） were randomized to receive a test dose of 5 ml of 0.15% ropivacaine with 0.5 μg.ml^-1 sufentanil （group S, n = 60） or 2.0 μg.ml^-1 fentanyl （group F, n = 60） and were observed for 5 ml. When correct placement of epidural catheter was confirmed another 10 ml was given. PCEA was commenced with 0.1% ropivacaine ＋ 0.5 μg. ml^-1 sufentanil/2.0 μg. ml^- 1 fentanyl. The PCEA pump was set up with a bolus of 6 ml and lockout interval of 15 min without background infusion. The following were recorded： （1） pain intensity was assessed using VAS （0-10） ; （2） motor block was assessed using Bromage scale; （3） onset of analgesia after epidural injection; （4） fetal HR; （5） maternal vital signs; （6） Apgar score; （7） labor process; （8） mode of delivery and （9） the total amount of analgesics comsumed. Results VAS scores were significantly decreased starting from 5 min after epidural analgesia was started. The VAS scores were significantly lower at 20, 30 and 60 min after epidural medication in group S than in group F. There were no significant differences in onset of analgesia, block height, the number of attempts and the number of successful delivered doses between the two groups. The amount of sufentanil consumed was （ 16 ± 86） μg and of fentanyl （70 ± 28） μg. The ratio was 1 ： 4.4. The duration of active phase or second stage and the mode of delivery were similar in both groups. Conclusion Equivalent doses of sufentanil and fentanyl plus ropivacaine provide good analgesia for labor.