蛛网膜下spinocath连续输注舒芬太尼行分娩镇痛对母婴的影响

Effects of Labor Analgesia with Continuous Subarachnoid Spinocath Infusion of Sufentanil on Maternal and Neonatal Outcomes

目的探讨蛛网膜下spinocath连续输注不同剂量舒芬太尼行分娩镇痛对母婴的影响。方法自愿接受分娩镇痛的足月初产妇120例(ASAⅠ-Ⅱ级),将其按随机数字表法分为4组,每组30例。镇痛药液的配置:A组生理盐水30mL+舒芬太尼45μg;B组生理盐水30mL+舒芬太尼60μg;C组生理盐水30mL+舒芬太尼75μg;D组生理盐水30mL+舒芬太尼90μg;4组其他处理均相同。自控镇痛(PCA)设置方案为背景剂量为2mL,维持剂量为2mL·h-1,PCA按压1次为1mL,锁时为45min。记录镇痛起效时间、首剂镇痛持续时间,PCA用药总量及PCA按压次数和产妇运动阻滞情况,记录产妇第一产程时间、第二产程时间、新生儿Apgar评分、不良反应发生率、镇痛满意度等。结果 C、D组产妇的镇痛起效时间明显较A组缩短,A组首剂镇痛持续时间较C、D组明显缩短,且差异有统计学意义(P<0.05);PCA用药总量及PCA按压次数D组较A组明显减少,差异有统计学意义(P<0.05);A组第一产程时间较B、C、D组延长(P<0.05);4组产妇无一出现恶心呕吐、低血压、呼吸抑制等不良反应,D组瘙痒的发生率较A、B、C组明显升高(P<0.05);无一例产妇对镇痛效果不满意。结论蛛网膜下spi-nocath单纯连续输注小剂量舒芬太尼可安全、有效地应用于分娩镇痛。

Objective To evaluate the effects of labor analgesia with continuous subarachnoid spinocath infusion of sufentanil on maternal and neonatal outcomes.Methods A total of 120 ASA Ⅰ-Ⅱ primiparas who voluntarily accepted labor analgesia were randomly divided into four groups,with 30 primiparas in each group.Group A received normal saline（NS） 30 mL and sufentanil 45 μg;Group B received NS 30 mL and sufentanil 60 μg;Group C received NS 30 mL and sufentanil 75 μg;Group D received NS 30 mL and sufentanil 90 μg.Patient controlled analgesia（PCA） regimens were：backgroud dose 2 mL,continuate injection dose 2 mL·h-1,PCA dose 1 mL per time and locked time 45 min.Analgesic onset time,total PCA dose,PCA button pressing times,motor block,duration of the first dose of analgesia,duration of the first stage of labour,duration of the second stage of labour,Apgar scores,adverse effect,and analgesia satisfaction were recorded.Results Compared with group A,analgesic onset time,significantly decreased but the duration of the first dose of analgesia obviously increased in group C and D（P〈0.05）.Total PCA dose and PCA button pressing times significantly decreased in group D（P〈0.05）.The duration of the first stage of labour in group B,C and D markedly decreased compared with group A（P〈0.05）.No primiparas had nausea and vomiting,hypotension,and respiratory depression.Compared with group D,the incidence of pruritus remarkably decreased in group A,B and C（P〈0.05）.All primiparas were satisfied with analgesic effects.Conclusion Continuous subarachnoid spinocath infusion of small doses of sufentanil is safe and effective for labor analgesia.