鞘内不同剂量舒芬太尼在腰硬联合阻滞分娩镇痛中的应用

Comparison of Different Doses of Intrathecal Sufentanil for Labor Analgesia with Combined Spinal-epidural Anesthesia

目的：观察鞘内应用不同剂量的舒芬太尼在腰硬联合阻滞分娩镇痛中的效果。方法：选择择期初产妇150例，随机分为5组：S2组、S3组、S组、Ss组、S6组。各组镇痛方法均采用蛛网膜下腔给药后硬膜外留管产妇自控镇痛。鞘内镇痛药物为舒芬太尼，各组剂量分别为2．0μg、3．0μg、4．0μg、5．0μg、6．0μg各组硬膜外维持用药相同。观察记录鞘内给药后5、10、15、30、60、90min时的VAS评分；维持时间、运动阻滞、各产程时间、出血量、新生儿lmin和5rainApgar评分及全程分娩镇痛的满意度；可能出现的不良反应。结果：S2组、S3组在各时间点镇痛效果均比S6组差，90min时S组的镇痛效果明显差于S6组。维持时间和满意度比较，S2组、S3组的维持时间明显短于S5组、S6组（P〈0．05），满意度最差，而S5组、S6组比较基本相似（P〉0．05）。各产程时间、出血量、新生儿Apgar评分、改良Bro—mage评分、瘙痒各组间无明显差异（P〉0．05）。结论：单纯舒芬太尼鞘内4．0～6．0μg均可提供安全、有效的分娩镇痛效果，但综合评估国人鞘内舒芬太尼分娩镇痛剂量以5．0μg更佳。

Objective：To obtain the excellent doses of intrathecal sufentanil by evaluating the effects of different doses （2-6μg） for labor analgesia. Methods： 150 parturients pregnant for the first time, were enrolled and divided into 5 groups randomly： group Sz, group S3, group S4, group S5, group S6, respectively. All of the parturients were given spinal injection. The study ended when the parturients requested further analgesia. VAS were assessed after 5,10,15,30, 60,90 minutes of the injection, duration of analgesia, motor block, total stage of labor, bleeding volume, Apgar score and side effects such as pruritus, nausea, hypotension＇and respiratory depression were noted. Results： The analgesic quality of group S2 and group S3 at any time was less satisfied than that of the group S6. After 90 minutes, the outcomes of the group S6 are more effective than group St. Nevertheless, no statistical differences were observed at other times among these groups（P〉0. 05）. In addition, total stage of labor, bleeding volume, Apgar score and side effects did not differ among the doses of sufentanil. Conclusion： Intrathecal sufentanil alone （4. 0 -6. 0μg） is safe and effective in labor analgesia. Moreover the excellent doses of intrathecal sufentanil is 5.0μg.