不同浓度罗哌卡因复合舒芬太尼双管硬膜外分娩镇痛对产妇分娩的影响

The Clinical Effects Comparison of Labor Double-catheter Epidural Analgesia with Different Concentration of Ropivacaine Combined Sufentanil on Parturients and Neonates

目的：分析比较不同浓度罗哌卡因复合舒芬太尼双管硬膜外分娩镇痛对产妇分娩的影响。方法：200例拟行硬膜外分娩镇痛的初产妇随机分为5组,每组40例。Ⅰ组：0.06%罗哌卡因＋0.4μg/m L舒芬太尼;Ⅱ组：0.08%罗哌卡因＋0.4μg/m L舒芬太尼;Ⅲ组：0.10%罗哌卡因＋0.4μg/m L舒芬太尼;Ⅳ组：0.12%罗哌卡因＋0.4μg/m L舒芬太尼;Ⅴ组：0.14%罗哌卡因＋0.4μg/m L舒芬太尼。同时选取未行分娩镇痛初产妇40例为对照组（Ⅵ组）。于镇痛前即刻（Ⅲ组于宫口扩张3 cm时）、镇痛开始后30 min、宫口扩张7~8 cm及10 cm,第二产程行视觉模拟评分（VAS）。下肢肌力采用改良Bromage评分。镇痛前即刻、镇痛开始后5、10、15、30 min和其后每隔l h记录母体血压（BP）、心率（HR）、脉搏血氧饱和度（Sp O2）和胎心。记录产程时间、胎儿Apgar评分及产妇满意度评分与不良反应。结果：Ⅴ组下肢麻木、低血压等不良反应高于Ⅰ~Ⅳ组（P〈0.05）,与Ⅵ组比较,Ⅰ~Ⅴ组镇痛开始后各时点VAS评分降低（P〈0.05）,Ⅰ组VAS评分高于Ⅱ~Ⅴ组（P〈0.05）,Ⅴ组第二产程时间较Ⅰ~Ⅳ组延长（P〈0.05）。结论：0.08%~0.12%罗哌卡因复合0.4ug/m L舒芬太尼双管硬膜外分娩镇痛可取得满意的镇痛效果,且不良反应少。

Objective To compare the effects of labor ropivacaine combined sufentanil on parturients and neonates double-catheter epidural analgesia with different concentration of Methods Two hundred nulliparous women of full term pramipara with double-catheter epidural analgesia were randomly were divided into 5 groups（n = 40 each）： 0.06 % ropivacaine combined 0.4ug/ml sufentanil （group Ⅰ ） ; 0.08 % ropivacaine combined 0.4ug/ml sufentanil （group Ⅱ ） ; 0.10 % ropivacaine combined 0.4ug/ml sufentanil （group Ⅲ ） ; 0.12 % ropivacaine combined 0.4ug/ml sufentanil （group Ⅳ ） ; 0.14 % ropivacaine combined 0.4ug/ml sufentanil （group V ）. Forty nulliparous women were chosen as control group（group Ⅵ ）.The intensity of pain was measured with VAS before analgesia, at 30 rain after beginning of PCEA and eervieal dilatation of 7-8 cm and 10 cm, the duration of 2st stage of labor. Degree of motor block was assessed by lower extremity muscle strength（modified Bmmage scale）. The length of every stage, duration of analgesia, maternal satisfaction, Apgar scores of the neonates and adverse effects were recorded. Results Group V had increased degree of adverse effects as compared with group Ⅰ - Ⅳ, Group Ⅰ - Ⅴ significantly reduced VAS score on the duration of different stage of labor as compared with group Ⅵ, Group Ⅰ had increased VAS score on the duration of different stage of labor as compared with group Ⅱ - Ⅴ ,and Group V increased the duration of 2st stage of labor as compared with group Ⅰ - Ⅳ. Conclusions Labor double-catheter epidural analgesia with 0.08 % - 0.12 % ropivacaine combined 0.4ug/ ml sufentanil can have more comfortable analgesia but does not increase adverse effects.