不同质量浓度舒芬太尼复合罗哌卡因用于分娩镇痛的效果评价

Analgesia effects of different concentrations of sulfentanyl combined with ropivacaine during labor

目的观察不同质量浓度的舒芬太尼复合罗哌卡因用于硬脊膜外腔阻滞分娩镇痛的效果及其对产程的影响,探讨舒芬太尼用于硬脊膜外腔阻滞分娩镇痛的合适浓度配方。方法选择足月妊娠初产妇120例,美国麻醉医师学会(ASA)分级Ⅰ级,年龄22～36岁。根据舒芬太尼的质量浓度随机分为4组:0.1%罗哌卡因组、舒芬太尼0.2μg/mL+0.1%罗哌卡因组、舒芬太尼0.4μg/mL+0.1%罗哌卡因组、舒芬太尼0.6μg/mL+0.1%罗哌卡因组。每组各30例,均采用持续硬脊膜外腔阻滞。分别记录硬脊膜外腔阻滞分娩镇痛前及镇痛后10、20、30min及宫口开全时的疼痛视觉模拟评分(VAS评分),观察产程进展、产后出血量及新生儿Apgar评分。结果 4组间产妇在镇痛前疼痛VAS评分的差异均无统计学意义(P值均>0.05);镇痛后10min,0.1%罗哌卡因+舒芬太尼0.4μg/mL组、0.1%罗哌卡因+舒芬太尼0.6μg/mL组的疼痛VAS评分均显著低于0.1%罗哌卡因组(P值均<0.05);镇痛后20min,0.1%罗哌卡因+舒芬太尼0.4μg/mL组、0.1%罗哌卡因+舒芬太尼0.6μg/mL组的疼痛VAS评分均显著低于0.1%罗哌卡因组,0.1%罗哌卡因+舒芬太尼0.6μg/mL组疼痛VAS评分显著低于0.1%罗哌卡因+舒芬太尼0.2μg/mL、0.1%罗哌卡因+舒芬太尼0.4μg/mL组(P值均<0.05)。0.1%罗哌卡因+舒芬太尼0.6μg/mL组尿潴留、瘙痒的发生率显著高于0.1%罗哌卡因组、0.1%罗哌卡因+舒芬太尼0.2μg/mL组及0.1%罗哌卡因+舒芬太尼0.4μg/mL组(P值均<0.05)。结论舒芬太尼复合罗哌卡因镇痛用于硬脊膜外腔阻滞分娩镇痛的效果优于单纯使用罗哌卡因,舒芬太尼0.4μg/mL+0.1%罗哌卡因的镇痛效果最好,且不良反应少,对第一、二产程、产后出血以及胎儿娩出后Apgar评分等均无影响。

Objective To observe the analgesia effect of continuous epidural block anesthesia with different concentrations of sulfentanyl combined with ropivacaine for labor, so as to explore the suitable concentration of sulfentanyl for labor analgesia. Methods Totally 120 full term pregnant women, American Society of Anesthesiologists （ASA） I - II level, aged 22-36 years old, were evenly randomized into 4 groups according to the concentrations of sufentanil. Continuous epidural block anesthesia was performed for all participants： group A; 0. 1% pure ropivacaine, group B.. sufentanil 0.2 μg/mL＋ 0. 1% ropivacaine, group C： sufentanil 0.4 μg/mL＋0. 1% ropivacaine, and group D： sufentanil 0.6 μg/mL ＋ 0. 1% ropivacaine. The VAS scores were recorded before and 10, 20, and 30 mins after analgesia. The labor process, postpartum blood loss and neonatal Apgar score were also observed. Results The VAS scores were similar in the four groups before analgesia. The VAS scores of group C, D were significantly lower than that of group A at both 10 mins and 20 mins after analgesia （all P〈0.05）. At 20 mins after analgesia, the VAS scores of group D was significantly lower than those of group B and C （both P〈0.05）. The incidence rates of urine detention and inching were significantly higher than those of the other three groups （all P〈0.05）. Conclusion Sulfentanyl combined with ropivacaine can achieve better outcome than ropivacaine alone for continuous epidural block anesthesia of labor, with 0.4 μg/mL sufentanil-t-0.1% ropivacaine having the best effect and less adverse effects. It has no effect on the first, second stages of labor, postpartum blood loss or neonatal Apgar score.