舒芬太尼鞘内注射用于腰硬联合阻滞分娩镇痛安全剂量的探讨

Safe dose of intrathecal injected sufentanil for the combined spinal-epidural anesthesia in delivery analgesia

目的探讨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有效性与安全性。方法选择择期初产妇150例,随机分为:A、B、C、D、E组。各组镇痛方法均采用腰硬联合阻滞镇痛。鞘内注射的镇痛药物为舒芬太尼,各组剂量分别为6.0、7.0、8.0、9.0、10.0μg;待产妇视觉模拟评分(VAS)≥3分时启用自控PCA泵维持镇痛,各组硬膜外维持用药相同为0.143%甲磺酸罗哌卡+0.3μg/mL的舒芬太尼。观察记录镇痛起效时间、分娩镇痛的满意度、首次给药镇痛维持时间、不良反应情况,分别测定脐带血血药浓度、新生儿血药浓度、新生儿Apgar评分。结果不同舒芬太尼剂量组镇痛起效时间、分娩镇痛的满意度、新生儿血药浓度、新生儿Apgar评分差异无统计学意义(P>0.05);5组新生儿体内血药浓度为零,差异无统计学意义(P>0.05);10.0μg剂量组鞘内首次给药镇痛持续时间为(233.93±62.624)min,脐带静脉血血药浓度为(0.093±0.057)μg/L,明显高于其他剂量组(P<0.05)。结论为了取得最佳镇痛效果,确保母婴安全,分娩镇痛中鞘内首次注射舒芬太尼应7～8μg为宜。

Objective To discuss the efficacy and safety of different doses of intrathecal sufentanil in combined spinal-epidural anesthesia for delivery analgesia.Methods A total of 150pregnant women were randomly divided into group A-E,giving sufentanil for dosage of 6.0,7.0,8.0,9.0and 10.0μg for combined spinal-epidural analgesia.PCA pump was activated,when VAS≥3.Epidural medication was 0.143% ropivacaine mesylate and 0.3μg/mL sufentanil.Analgesic onset time,labor analgesia satisfaction,first delivery analgesia duration,adverse reaction and so on were compared between different groups.Results Analgesic onset time,labor analgesia satisfaction,neonatal plasma concentrations,Apgar score of neonates and blood drug level in neonates were not statistically different between the 5groups（P0.05）.The first delivery analgesia duration and umbilical cord blood serum concentrations in group E were statistically different with other groups（P0.05）.Conclusion The first time intrathecal injection of sufentanil should be 7-8μg to obtain optimal delivery analgesia effect and protect the safety of puerpera and neonate.