不同剂量舒芬太尼联合罗哌卡因腰硬联合镇痛在分娩术中的应用

Study the application of different doses of sufentanil combined ropivacaine lumbar epidural anesthesia in labor analgesia

目的 研究不同剂量舒芬太尼联合罗哌卡因腰硬联合镇痛在镇痛分娩术中的应用.方法 选择自2011年5月-2013年2月期间来我院进行分娩的单胎头位且足月的初产妇72例作为研究对象.将所有孕妇随机分成3组,每组24例.3组分别给予舒芬太尼剂量为2 μg（A组）、4 μg（B组）和6 μg（C组）.于L2-3行腰硬联合穿刺,成功后鞘内注射各组拟定剂量的舒芬太尼和2.5mg的罗哌卡因.然后置入硬膜外导管,并连接硬膜外自控镇痛泵（PCA泵）.记录各组首次用药持续时间、药物起效时间、鞘内注射给药后VAS疼痛评分、罗哌卡因总用量、运动阻滞情况、产程时间、出血量、新生儿1min和5min的Apgar评分等.结果 3组镇痛效果均良好,VAS评分无显著性差异（P＞0.05）.但舒芬太尼B组和C组较A组首剂给药后作用持续时间长、药物起效快,差异具有显著性（P＜0.05）.舒芬太尼A组罗哌卡因总用量为（22.37±6.33）mg明显高于B组的（15.79±5.64）mg和C组的（14.76±5.17）mg（P＜0.05）;在运动阻滞发生情况方面,A组发生轻度运动神经阻滞明显多于B组和C组（P＜0.05）;3组在产程时间、出血量以及新生儿1 min和5 min Apgar评分方面比较,无显著性差异（P＞0.05）.结论 舒芬太尼联合罗哌卡因鞘内注射在镇痛分娩术中均安全有效,且4 μg舒芬太尼联合2.5 mg罗哌卡因腰硬联合镇痛在镇痛分娩术中的剂量较理想.

Objective To study the application of different doses of sufentanil combined ropivacaine lumbar epidural anesthesia in labor analgesia. Methods Seventy-two cases pregnant women were choose who were foot in early. All of the pregnant women were divided into 3 groups,24 cases in each group. The dose was 2p.g（group A） 、4 ug （group B） and 6ug （group C）. Intrathecal injection sufentanil combined ropivaeaine after lumbar epidural anesthesia. Then connected to the PCA pump. Record the VAS score,the onset and duration time,ropivaeaine consumption,labor,adverse reactions indicators and Apgar score of lmin and 5min. Results Group B and group C showed shorter onset time of analgesia,longer maintenance time than group A （P〈0.05） ;and the dosage of rdpivaeaine of group B and group C was （15.79±5.64） mg and （14.76±5.17） mg which was less than group A＇s （22.37±6.33）mg （P〈0.05） ;The incidence of motor block in group A was higher than that of group B and group C （P〈0.05）. There were no significant differences in labor,amount of bleeding and Apgar score of 1min and 5 rain in 3 groups （P〉0.05）. Conclusion Combination of sulfentanyl and ropivacaine in labor analgesia are safety.4 ug sufentanil combined 2.5 mg ropivaeaine lumbar epidural anesthesia in labor analgesia have a ideal curative effect.