罗哌卡因复合舒芬太尼硬膜外分娩镇痛对母婴的影响

Effects of epidural analgesia with ropivacaine plus sufentanil on mother in labor and newborn

目的评价0．1％罗哌卡因复合不同浓度的舒芬太尼硬膜外自控镇痛用于分娩镇痛对母婴的影响及最佳配伍的浓度和剂量。方法选择自愿要求分娩镇痛足月初产妇（ASAⅠ～Ⅱ）100例，随机分为5组，每组20例。F组：0.1％罗哌卡因复合2μg／ml芬太尼为对照组；S1、S2、S3、S4组分别用0.1％罗哌卡因复合0．3、0．4、0．6及0．8μg／ml舒芬太尼。宫口开3—4cm时，硬膜外穿刺置管，分别按分组注入10—15ml罗哌卡因与舒芬太尼或芬太尼混合溶液，0．5h后接镇痛泵，泵入与初次注药相同配比药液。观察并记录镇痛前后产妇生命体征变化、镇痛效果、Bromage改良评分、分娩方式、副作用。结果镇痛后5及10min VAS评分S1、F组高于S2、S3、S4组（P〈0．05），但镇痛后30minVAS评分，仅S1组高于S2、S3、S4、F组（P〈0．05）。60和90min时间段各组间差异无统计学意义（P〉0．05）。镇痛起效时间、完善时间，S2、S3、S4显著快于S1、F组（P〈0．05），S2、S3、S4组各组间差异无统计学意义（P〉0．05）。Bromage改良评分、分娩方式，各组间差异无统计学意义（P〉0、05）。瘙痒发生率S4组明显高于其他组（P〈0．05）。结论0．1％罗哌卡因复合0．4μg／ml舒芬太尼分娩镇痛与复合芬太尼及其他浓度的舒芬太尼比较，镇痛确切，起效快，副作用小。为最佳配伍处方。

Objective To evaluate the effects and the most appropriate concentration of epidural analgesia with ropivacaine plus sufentanil on the mother and the newborn using self administrated epidural analgesia in labor. Methods 100 partufients were randomly assigned to five groups（ n = 20 for each group）. Group F（contml） ,0.1% ropivacaine plus fentanyl 2gg/ml was used. In experimental groups： S1, S2, S3, S4,0.1% ropivacaine was administrated with the addition of 0.3,0.4, 0.6 and 0.8 μg/ml of sufentanil respectively. All parturients with cervical dilatation of 3 - 4 cm received 10 - 15 ml solution of epidural anesthetic of ropivacaine plus sufentanil or fentanyl. The self administrated epidural analgesia were initiated after epidural anesthesia 30 min, injected anesthetic solution as above in each group. The following data were collected：the vital signs, VAS, the onset time of analgesia , Bromage motor score of block, mode of delivery, and side effects. Results The VAS at 5 min and 10 min in the S2, S3 and S4 groups were lower than those in the S1 and F group （ P 〈 0.05）, At 30 min in the F,S2,S3 and S4 groups,VAS were lower than that in the S1 group （ P 〈0.05） .There were no differences of VAS at 60 min,90 rain among five groups （ P 〉 0.05） .The onset time of analgesia in S2,S3 and S4 were faster than those S1 and F （ P 〈 0.05） ;Motor block did not occur in any patient.The mode of delivery, neonatal Apgar scores were similar among five groups The incidence of pruritus was significantly higher in group S4 than others. Conclusion ropivacaine 0.1% plus sufentanil 0.4 μg/ml provides effective analgesia with less side effects.