罗哌卡因复合舒芬太尼腰麻-硬膜外联合阻滞麻醉在分娩镇痛中的临床应用

Application of ropivacaine combined with sufentanil for combined spinal^epidural anesthesia in labor analgesia

目的观察罗哌卡因复合舒芬太尼腰麻顿膜外联合阻滞麻醉（combined spinal-epiduralanesthesia，CSEA）用于分娩镇痛的临床效果。方法选择来我院分娩的初产妇120例，使用随机数字表法将其分为对照组和镇痛组，每组60例。对照组采用常规产科护理及处理的自然分娩方式，镇痛组在对照组护理、处理的基础上，采用CSEA分娩镇痛的方式。对两组产妇的镇痛效果、产程时间、产后出血量、分娩方式及新生儿Apgar评分进行对比观察，观察镇痛组的副作用。结果两组产妇镇痛前宫缩时视觉模拟评分（visualanaloguescale，VAS）比较，差异无统计学意义（P〉0．05）；镇痛后镇痛组第一、第二、第三产程宫缩时的VAS评分均低于对照组（P〈0．05）；镇痛组第一产程时间（194±40）min短于对照组（350±74）min（P〈0．05）；镇痛组产妇剖宫产率（3．3％）低于对照组（15．0％）（P〈0．05）；两组产妇产后出血量及新生儿出生后1、5、10min时Apgar评分的比较，差异无统计学意义；镇痛组有6例产妇出现恶心，余未发现明显副作用。结论罗哌卡因复合舒芬太尼CSEA用于分娩镇痛能减轻产妇在分娩过程中的疼痛，缩短第一产程，降低剖宫产率，且对新生儿无损害，值得临床上广泛应用。

Objective To observe the efficacy of ropivacaine combined with sufentanil for combined spinal-epidural anesthesia （CSEA） in labor analgesia. Methods One hundred and twenty pregnant women were randomly divided into two groups （n=60）, painless labor was applied in the analgesia group, while natural labor was applied in the control group. We observed and compared the analgesic effect, time of labor stage, amount of postpartum hemorrhage, delivery mode and the newborns Apgar score of the two groups, the adverse reactions in the analgesia group was also observed. Results There was no significant difference in the visual analogue scale （VAS） between the two groups before analgesia, while the VAS in the analgesia group were lower than that in the control group during the whole stages of labor（P〈0.05 ）, the time of the first labor stage[ （194±40） min] in the analgesia group were shorter than that in the control group [ （350±74） min]（P〈0.05）,the rate of cesarean section in the analgesia group （3.3%） was lower than that in the control group （ 15.0% ）. There were no significant differences in the amount of postpartum hemorrhage and the newborns Apgar score between the two groups（P〉0.05）. Maternal nausea occurred in 6 patients in the analgesia group. Conclusions The application of labor analgesia using ropivacaine combined with sufentanil for CSEA could improve the effect of analgesia, shorten the time of the first labor stage, reduce the incidence of cesarean section and had less impact on materal-neonatal safety.