罗哌卡因复合芬太尼或苏芬太尼在分娩镇痛中的疗效比较

Comparison of the effect of ropivacaine combined with fentanyl or sufentanil in labor analgesia

目的：比较罗哌卡因复合芬太尼或苏芬太尼在分娩镇痛中的疗效。方法选取分娩的初产妇116例进行研究。按数字表法将产妇随机分成观察组（58例，接受罗哌卡因及苏芬太尼镇痛）以及对照组（接受罗哌卡因及芬太尼镇痛），分别在两组产妇麻醉诱导前（T0），给药后30 min（T1），60 min（T2），180 min（T3）时检测其平均动脉压（MAP）和心率（HR），并进行疼痛数字评价量表（NRS 评分）评定，记录两组母婴并发症情况。分析两组分娩镇痛后分娩方式与新生儿 Apgar 评分水平的变化。结果两组产妇 T0～T3时期的 MAP及 HR 水平比较差异均无统计学意义（tMAP ＝0．123、1．078、0．212、0．047，P ＝0．903、0．283、0．832、0．963；tHR ＝0．033、0．289、0．288、0．036，P ＝0．974、0．773、0．774、0．972）；两组 T1～T3时的 NRS 评分均显著低于 T0时；观察组 T1～T3时的 NRS 评分为（2．21±0．36）分、（1．78±0．24）分、（1．83±0．25）分，均显著低于对照组的（3．61±0．75）分，（3．22±0．12）分，（2．84±0．26）分，差异有统计学意义（t ＝12．816、40．871、21．325，P ＝0．000、0．000、0．000）；观察组共有0例（0．00％）心动过缓，显著少于对照组的4例（6．90％），差异有统计学意义（χ^2＝4．143，P ＝0．042）。两组分娩镇痛后产妇的分娩方式及新生儿出生后1 min、5 min 的 Apgar 评分相比，差异无统计学意义（χ^2＝0．703、t ＝0．631、1．149，P ＝0．402、0．530、0．253）。结论罗哌卡因联合苏芬太尼或者芬太尼应用于分娩镇痛过程中，对产妇的生命体征和新生儿均无影响，均有良好的镇痛效果，其中罗哌卡因联合苏芬太尼镇痛效果更强，安全性更高。

Objective To compare the effect oropivacaine combined with fentanyl or sufentanil in labor anal-gesia.Methods 116 cases of maternal birth in obstetrics and gynecology were selected.According to the random number table method,116 cases of parturients were randomly divided into observation group （58 cases,received ropiv-acaine and sufentanil analgesia）and control group （received ropivacaine and fentanyl）.In two groups of maternal anesthesia before induction （T0 ）,used the drug after 30min（T1 ）,60min（T2 ）,180min（T3 ）detection of the mean arterial pressure （MAP）and heart rate （HR）,and digital evaluation table Rating Scale （NRS）.The complications of maternal and infant in the two groups were recorded,the change of the mode of delivery and the Apgar score of neo-nates in the two groups were analyzed.Results There were no significant differences in the levels of MAP and HR between the two groups in T0-T3 （tMAP =0.123,1.078,0.212,0.047;P =0.903,0.283,0.832,0.963;tHR =0.033, 0.289,0.288,0.036;P =0.974,0.773,0.774,0.972）.The NRS scores in T1 -T3 of the two groups were significantly lower than those in the T0;the T1 -T3 scores of the observation group were （2.21 ±0.36 ）points,（1.78 ± 0.24）points,（1.83 ±0.25）points,which were significantly lower than （3.61 ±0.75）points,（3.22 ±0.12）points,＆amp;nbsp;（2.84 ±0.26）points of the control group（t =12.816,40.871,21.325,P =0.000,0.000,0.000）.In the observation group,there was 0 case （0.00%）had cardiac arrhythmia,the control group had 4 cases （6.90%）,and the differ-ence was statistically significant（χ^2 =4.143,P =0.042）.Two groups of labor analgesia,the way of delivery and birth of the newborn after birth,1min,5min of Apgar score were compared,the differences were not statistically significant （χ^2 =0.703,t =0.631,1.149,P =0.402,0.530,0.253）.Conclusion Ropivacaine combined with sufentanil or fentanyl in analgesia have no effect in childbirth and maternal vital signs and neonatal,and have good analgesic effect, but ropivacaine combined with sufentanil has stronger analgesic effect,higher safety.