罗哌卡因复合舒芬太尼硬膜外分娩镇痛用于瘢痕子宫产妇阴道分娩的镇痛效果

Analgesic efficacy of epidural labor analgesia with ropivacaine combined with sulfentanil in the full term pregnant puerperants with scar uterus undergoing vaginal delivery

目的观察不同浓度罗哌卡因复合舒芬太尼硬膜外分娩镇痛用于瘢痕子宫产妇再次足月妊娠阴道分娩的镇痛效果。方法接受分娩镇痛的瘢痕子宫再次妊娠产妇120例随机分为四组,每组30例。A、B和C组分别采用0.1%罗哌卡因、0.15%罗哌卡因和0.2%罗哌卡因复合舒芬太尼0.5μg/ml行硬膜外分娩镇痛,D组未接受镇痛分娩作为对照。比较分娩期VAS疼痛评分、产程时间、产后出血量、新生儿Apgar评分和催产素使用情况。结果 A、B和C组分娩镇痛效果均较满意,VAS疼痛评分依次为C组<B组<A组(P<0.05)。B组第一产程时间短于D组(P<0.05);C组第二产程时间较其他组延长(P<0.05),且产后出血量也多于其他组(P<0.05)。B组和C组催产素使用率高于D组(P<0.05),但无一例发生子宫破裂。四组顺产率、新生儿1-min和5-min Apgar评分相仿(P>0.05)。结论罗哌卡因复合舒芬太尼用于瘢痕子宫产妇再次妊娠分娩镇痛效果满意,推荐镇痛药物为0.15%罗哌卡因+舒芬太尼0.5μg/ml。

Objective To observe the analgesic efficacy of epidural labor analgesia with sulfentanil combined with different concentrations of ropivacaine in the full term pregnant puerperants with scar uterus undergoing vaginal delivery.Methods A total of 120 full term pregnant puerperants with scar uterus undergoing vaginal delivery was assigned into four groups with 30 cases each.The epidural labor analgesia with sulfentanil 0.5μg/ml combined with 0.1%（group A）,0.15%（group B）or 0.2%ropivacaine（group C）was performed,which was not used in group D as the control.The VAS pain score during vaginal delivery,the times of birth process,postpartum blood loss,neonatal Apgar score and the use of oxytocin were compared among four groups.Results The analgesic efficacy of epidural labor analgesia was all satisfied in groups of A,B and C with an order of C〈B〈A in pain score（P〈0.05）.The first birth process was shorter in group B than that in group D（P〈0.05）.The second birth process was longer in group C than that in groups of D,A and B with more blood loss（P〈0.05）.The propotion of puerperants with the use of oxytocin was more in groups of C and B than that in group D（P〈0.05）,but there was no case with hysterorrhexis.The rate of natural delivery and neonatal one-minute and five-minute Apgar score were not significantly different among four groups（P〉0.05）.Conclusion Analgesic efficacy of epidural labor analgesia with sulfentanil combined with ropivacaine is satisfactory in the full term pregnant puerperants with scar uterus undergoing vaginal delivery,for which 0.15% ropivacaine combined with sulfentanil0.5μg/ml is recommended.