舒芬太尼与芬太尼在腰硬联合阻滞分娩镇痛中的应用比较

Comparison of Sufentanil and Fentanyl for Combined Spinal-epidural Anesthesia for Labor Analgesia

目的比较舒芬太尼与芬太尼用于腰硬联合阻滞分娩镇痛中的镇痛效果、对产程和胎儿影响及其不良反应。方法选择足月单胎初产妇90例,随机分3组:舒芬太尼组(S组)、芬太尼组(F组)、无镇痛组(W组)各30例。S组和F组镇痛方法均采用CSEA+PCA模式,镇痛药物S组:鞘内用舒芬太尼5μg+NS至2ml,硬膜外维持用舒芬太尼0.2μg/ml+0.1%罗哌卡因+NS共100ml,F组:鞘内用芬太尼20μg+NS至2ml,硬外维持用芬太尼1.5μg/ml+0.1%罗哌卡因+NS共100ml。W组不行镇痛,按产科常规处理。观察鞘内给药5、10、30、60、90min后VAS评分,首次加药时间,各产程时间,分娩方式,催产素使用情况,新生儿娩出后即刻脐静脉血气分析、5minApagr评分,Bromage评分,不良反应等。结果各产程时间、剖宫产率、器械助产率3组间无差异性,催产素使用镇痛组间无差异性,但与无镇痛组有显著性差异。两镇痛组间,在5min和90minVAS评分及首次需加药时间有显著性差异,其余时段两组无显著性差异。新生儿5minApgar评分,3组间无显著性差异。不良反应主要为瘙痒与镇静,但两镇痛组无显著性差异,未观察到其他不良反应。结论舒芬太尼用于腰硬联合阻滞分娩镇痛能提供良好的镇痛效果,与芬太尼相比,具有起效更快,镇痛更强,持续时间更长的优点,而且不影响产程,对新生儿无明显影响。

Objective To compare fentanyl with sufentanil in combined spinal and epidural anesthesia in spontaneous labor. End points included efficacy and duration of analgesia, unwanted effects, impact on labor and neonatal outcomes. Methods Inclusion criteria： a term labour, vertex presentation, singleton foetus in a healthy nulliparous women. Ninety women were randomized to receive combined spinal and epidural or no analgesia （W group）. Analgesia was either fentanyl （F group） or sufentanil based （S group）. The F group received 20 micrograms of intrathecal fentanyl with a 1.5 microg/ml fentanyl plus 1 mg/ml ropivacaine epidural. The S group received 5 micrograms of intrathecal sufentanil with a O. 2 microg/ml sufentanil plus 1 mg/ml ropivacaine epidural. Maternal analgesia was assessed by a visual analogue score （VAS） at 5, 10, 30, 60 and 90 minutes after intrathecal block. The time of any request for additional analgesia post intrathecal block was recorded. Labour duration, delivery mode, neonatal Apgar scores, Bromage score and unwanted effects were all recorded. Results There was no significant differences between the three groups in terms of labour duration, delivery mode, Apgar scores or umbilical cord pH. The utility rate of oxytocin was significantly increased in S and F groups in comparison to that in the W group. VAS was significantly lower at 5 and 90 minutes in S group compared to that at the F group. The S group requested less additional analgesia. There were no significant differences in VAS at 10, 30 and 60 minutes. Side effects of spinal - epidural analgesia included pruritus and sedation. There was no difference in Side effects between the two analgsiea groups. Conclusion Sufentanil is preferable to fentanyl in onset ,potency and duration of analgesia. Both sufentanil and fentanyl have no effect on duration of labour and neonatal outcomes. There is no difference in Side effects.