舒芬太尼复合低浓度的罗哌卡因在分娩镇痛中的应用

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

目的探讨舒芬太尼复合罗哌卡因用于硬膜外分娩镇痛对产妇及新生儿的影响。方法选择无麻醉禁忌证、无经阴道分娩禁忌且自愿接受硬膜外自控镇痛(PCEA)的初产妇80例,均分成两组:舒芬太尼组(A组)0.1%罗哌卡因+舒芬太尼0.3μg/ml的混合液,芬太尼组(B组)0.1%罗哌卡因+芬太尼2μg/ml的混合液,另外设置对照组(C组40例)未接受镇痛的初产妇。结果 A组与B组比较,A组在麻醉后10 min,停药1 h后VAS评分下降显著,疼痛明显减轻(P<0.05),两组均无明显运动阻滞;A,B两组相对于C组第一产程时间缩短,第二产程时间延长,有统计学意义(P<0.05);3组产妇产钳术,剖宫产率无统计学意义(P>0.05),但A.B两组缩宫素的使用率明显高于C组(P<0.05);3组新生儿Apgar评分无统计学差异(P>0.05),镇痛组皮肤瘙痒,恶心呕吐有一定的发生率,但无统计学意义.结论舒芬太尼复合低浓度的罗哌卡因用于硬膜外分娩镇痛具有起效快,镇痛维持时间长,能缩短第一产程,延长第二产程,增加缩宫素使用率但不增加剖宫产率和产钳率。

Objective To study the effects of epidural analgesia with ropivacaine plus sufentanil on the mother and the newborn using patient-controlled epidural analgesia in labor. Methods B0 parturients who re- quested analgesia were randomly assigned to two groups （n = 40 in the each group）. Group A,0. 1% ropivacaine plus 0. 3 p,g/ml sufentanil, Group B 0. 1% ropivacaine plus 2 p^g/ml fentanyl, Group C （n =40） ,received no analgesia. The VAS score, Bromage motor score of block, labor duration, mode of delivery, amount of oxytocin re- quired and Apgar scores, side effects were recorded. Results Compared to group B, group A had higher rate of satisfactory analgesia （ P 〈 0. 05 ） in VAS score on 10 min after analgesia and an hour after stop injecting drug. Compared to group C, the first stage of labor was shorted with group A and B, and amount of oxytocin re- quired was increased. There was no significant difference in mode of delivery, Apgar scores and side effects. Conclusion Epidural anesthesia with sufentanil is effective and safety for labor analgesia.