小剂量罗哌卡因复合舒芬太尼腰硬联合分娩镇痛的临床观察

The clinical observation of low dose of ropivacaine with sufentanil for combined spinal and epidural labor analgesia

目的观察小剂量罗哌卡因复合舒芬太尼腰硬联合分娩镇痛的有效性和安全性。方法前瞻性选择平谷区妇幼保健院2016年10月至2017年10月100例拟在腰硬联合分娩镇痛下行经阴道分娩的健康初产妇,随机分成罗哌卡因复合舒芬太尼组(RS组,n=50)和罗哌卡因单独应用组(R组,n=50),所有产妇均在第一产程潜伏期即开始实施分娩镇痛,其中RS组先在蛛网膜下腔中注入由生理盐水稀释至3 ml的罗哌卡因3 mg和舒芬太尼2.5μg,R组先在蛛网膜下腔中注入由生理盐水稀释至3 ml的罗哌卡因3 mg。两组均在视觉疼痛模拟评分达到3分以上时经留置硬膜外导管实施由自控镇痛泵(背景剂量6 ml/h,负荷量6 ml,锁定时间15 min)引导的硬膜外分娩镇痛,药物为由生理盐水稀释至100 ml的罗哌卡因100 mg和舒芬太尼50μg。记录两组镇痛作用起效时间、首次给药后镇痛作用维持时间、特定不同时点的疼痛视觉模拟评分、运动阻滞状态、产程时间、分娩方式、新生儿Apgar评分、不良反应和产妇对镇痛的满意度评分。结果 RS组镇痛起效时间明显短于R组(P<0.05),RS组首次镇痛作用维持时间明显长于R组(P<0.05),RS组在蛛网膜下腔给药后3 min、5 min、10 min、60 min时的疼痛程度明显低于R组(P<0.05),RS组产妇对镇痛的满意度评分明显高于R组(P<0.05)。两组在首次给药后120 min、宫口扩张7~8 cm和宫口开全时的疼痛程度、运动阻滞状态、产程时间、分娩方式、新生儿Apgar评分及不良反应方面无显著性差异(P>0.05)。结论罗哌卡因3mg复合舒芬太尼2.5μg腰硬联合分娩镇痛能安全地用于分娩镇痛,与单独应用罗哌卡因相比,它具有更快的镇痛作用显效时间、更长的首次给药后镇痛作用维持时间以及更好的产妇镇痛满意度。

Objective To observe the effect and safety of low dose of ropivacaine with sufentanil for combined spinal and epidural labor analgesia（ CSELA）. Methods A hundred healthy primipara undergoing vaginal delivery under CSELA in Maternal and Child Health Hospital of Pinggu District between October 2016 and October 2017 were prospectively chosen and randomly assigned to group RS（ n = 50） and group R（ n= 50）. CSELA was initiated for all primipara in latent phase of the first labor stage. Ropivacaine 3 mg with sufentanil 2. 5 μg diluted in 0. 9% sodium chloride 3 ml was firstly injected subarachnoid space in group RS and ropivacaine 3 mg alone diluted in 0. 9% sodium chloride 3 ml was firstly injected subarachnoid space in group S. Self-controlled Analgesia Pump containing ropivacaine 100 mg with sufentanil 50 μg diluted in 0. 9% sodium chloride 100 ml was switched on via preserved epidural catheter when visual analogue scale（ VAS） reached more than three in both groups.The setting was 6 ml per hour for basal infusion rate,6 ml for loading dose,and 15 min for locking time. Items included onset time for analgesia（ OTA）,maintaining time for analgesia（ MTA）,visual analogue scale（ VAS） at different time points including 3 min,5 min,10 min,60 min,120 min post medication done in subarachnoid space and cervical dilatation 7 ~ 8 cm and 10 cm,motion block status（ MBS）,duration of first labor stage（ DFLS） and second labor stage（ DSLS）,mode of delivery（ MD）,newborn＇s Apgar score（ NAS）,side effects and satisfaction scale from primipara（ SSP）. Results OTA in group RS was significantly shorter than that in group S（ P〈0. 05）. MTA in group RS was significantly longer than that in group S（ P〈0. 05）. VAS at 3 min,5 min,10 min and 60 min post medication done in subarachnoid space in group RS were significantly lower than those in group S（ P〈0. 05）. SSP in group RS was significantly higher than that in group S（ P〈0. 05）. There was no significant difference in VAS at 120 min post medication done in subarachnoid space and cervical dilatation 7 ~ 8 cm and 10 cm,MBS,DFLS and DSLS,MD,NAS,and side effects between two groups（ P〈0. 05）. Conclusion Ropivacaine 3 mg with sufentanil 2. 5 μg could be effectively and safely used for CSELA because of its quicker OTA,longer MTA,lower VAS at specific time points and Higher SSP comparing with ropivacaine used alone for CSELA.