不同浓度舒芬太尼复合罗哌卡因用于硬膜外脉冲技术在分娩镇痛中的应用

Effect of different dose of sufentanil combined with ropivacaine intermittent epidural bolus on labor analgesia

目的:采用硬膜外脉冲注入技术,探讨不同浓度的舒芬太尼复合罗哌卡因用于产妇分娩镇痛的效果。方法:将弋矶山医院住院待产的90例孕妇随机分为S 0.3组(0.3μg/mL舒芬太尼+0.1%罗哌卡因),S 0.5组(0.5μg/mL舒芬太尼+0.1%罗哌卡因)和S 0.7组(0.7μg/mL舒芬太尼+0.1%罗哌卡因),3组均采用硬膜外脉冲注入技术进行产妇的分娩镇痛。记录产妇在镇痛前(T_(0))、镇痛后10 min(T_(1))、镇痛后30 min(T_(2))、镇痛后1 h(T_(3))、镇痛后2 h(T_(4))、宫口开全时(T_(5))、胎儿娩出时(T_(6))各个时间点的VAS评分。记录产妇各个产程时间、剖宫产率、使用催产素情况及阴道出血量情况。记录新生儿的胎心率及新生儿出生后l、5 min的Apgar评分和24 h新生儿神经行为学(NBNA)评分。记录产妇不良反应的发生率。结果:3组产妇的一般情况如年龄、体质量及孕周数差异均无统计学意义(P>0.05)。S 0.5组和S 0.7组T_(1)~T_(6)时VAS评分较S 0.3组降低(P<0.05);而S 0.5组和S 0.7组间VAS评分差异无统计学意义(P>0.05)。3组各个产程时间、分娩方式、使用催产素情况和阴道出血量差异均无统计学意义(P>0.05)。3组新生儿体质量、胎心率、出生后1、5 min的Apgar评分和NBNA评分差异均无统计学意义(P>0.05)。S 0.7组产妇皮肤瘙痒的发生率较S 0.3组增加(P<0.05)。结论:0.1%罗哌卡因复合0.5μg/mL舒芬太尼用于硬膜外脉冲注入分娩镇痛具有更佳的镇痛效果,不良反应少,值得在临床上推广。

Objective:To observe the effects of different concentration of sufentanil plus ropivacaine for analgesia in labor by intermittent epidural bolus.Methods:Ninety puerperae were randomly divided into group S 0.3(0.3μg/mL sufentanil+0.1%ropivacaine),S 0.5(0.5μg/mL sufentanil+0.1%ropivacaine)and S 0.7(0.7μg/mL sufentanil+0.1%ropivacaine),and underwent epidural analgesia by intermittent epidural bolus.Scoring on the Visual Analog Scale(VAS)was measured and maintained in all women before analgesia(T_(0)),10 min(T_(1)),30 min(T_(2)),1 h(T_(3))and 2 h after analgesia(T_(4)),full dilation of cervix(T_(5)),and at the time of delivery(T_(6)).The timing of the first,the second and the third stage of labor,mode of delivery,use of oxytocin and vaginal bleeding were also recorded,and neonatal fetal heart rate,Apgar scores at 1 and 5 min after birth,neonatal neurobehavioral scores(NBNA)at 24 h after birth were measured.The adverse reactions during analgesia were maintained.Results:There was no significant difference in age,body weight and gestational age among the three groups(P>0.05).Scoring on the VAS was significantly lower at T_(1)-T_(6) in group S 0.5 and group S 0.7 than in group S 0.3(P<0.05),yet remained insignificant between group S 0.5 and S 0.7(P>0.05).There was no significant difference in three stages of labor,delivery mode,use of oxytocin,vaginal bleeding,neonatal fetal heart rate,Apgar score and NBNA score at 1 and 5 min after birth among the three groups(all P>0.05),whereas incidence of skin itching in S 0.7 group was significantly higher than that in S 0.3 group(P<0.05).Conclusion:Combined use of 0.1%ropivacaine with 0.5μg/mL sufentanil for labor analgesia by intermittent epidural bolus injection can produce better analgesic effects without increasing adverse reactions,and is worthy of wider clinical recommendation.