舒芬太尼分娩镇痛对母婴循环影响的观察

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

目的比较0.1%罗哌卡因复合不同浓度的舒芬太尼及芬太尼硬膜外自控镇痛(PCEA)用于分娩镇痛对母婴循环的影响。方法选择自愿要求分娩镇痛的足月初产妇(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～S4组均0.1%罗哌卡因复合不同浓度舒芬太尼行PCEA基础注药速率为5ml/h,PCA量为2ml/次,锁定时间15min。观察并记录镇痛前后产妇血压、心率、胎儿心率变化,镇痛效果:镇痛前、镇痛后5、10、30、60、90min视觉模拟疼痛评分法(VAS)评分,镇痛起效、完善时间,运动神经阻滞Bromage改良评分,镇痛前(宫口开大3～4cm)、宫口开全母血一氧化氮浓度、脐静脉血一氧化氮浓度,分娩方式,Apgar评分,副作用。结果镇痛效果:5组中镇痛后VAS评分较镇痛前明显下降(P<0.01),镇痛后5～10min,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)。镇痛起效、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)。其他观测指标无明显差异。不良反应:瘙痒的发生S4组高于其他组(P<0.05)。结论舒芬太尼用于分娩镇痛对母婴循环系统无不良影响,且较芬太尼起效快镇痛强,不延长产程,不增加器械助产率。0.1%罗哌卡因复合0.4μg/ml舒芬太尼分娩镇痛,更适合临床推广。

Objective To study the effects of epidural analgesia with ropivacaine plus sufentanfl on the mother and the newborn using patient-controlled epidural analgesia in labor and make sure, the most appropriate concentration of them. Methods 100 parturients who requested analgesia were randomly assigned to five groups（ n = 20 in the each group）. Group F（group Ct） ,0.1% mpivacaine plus 2μg/ml fentanyl, Experimental groups： S1, 0.1% mpivacaine plus 0.3μg/ml sufentanil. S2,0.1% ropivacaine plus 0.4μg/ml sufentanil. S3,0.1% ropivacaine plus 0.5μg/ml sufentanil. S4,0.1% ropivacaine plus 0.75μg/rnl sufentanil. All patients with cervical dilatation of 3-4cm received the solution of epidural anesthetic of ropivacaine plus sufentanil or fentanyl 10 - 15 ml .The PCEA were ilfitiated after epidural anesthetia 30 min, injected anesthetic solution as above each group . The following data were collected： The vital signs, BP, HR of parturients, fetus heart rate, concentration of NO of mother at pre-analgesia and post-analgesia, and concentration of NO of umbilical venous blood ,Visual analogue score（VAS）, the onset and perfect time of analgesia , Bromage motor scorn of block after analgesia, labor duration, mode of delivery, Apgar scores, side effects. Results There was no difference at fetus heart rate between pre-analgesia and post-analgesia （ P 〉 0.05 ）. There were no significant difterences in concentration of NO of mother among five groups. And so on of umbilical venous blood.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 the other time intervals（60min,90min） among five groups （ P 〉 0.05） .The onset and perfect 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 duration of labor, the mode of delivery,the incidence of cesarean, usage of oxytocin and neonatal Apgar scores were similar among five groups The incidence of pruritus was significantly higher in group S4 than others＇. Conclusion In five groups, there are litter influence of epidural analgesia for circulation on the mother and infants in labor. 0.1% ropivacaine plus 0.4μg/ml sufentanil is the best dosage among five groups with litter side effects worth clinically extensive application in obstetrics.