不同浓度罗哌卡因复合舒芬太尼在硬膜外阶梯式分娩镇痛中的应用

Application of Different Concentrations of Ropivacaine Combined with Sufentanil in Epidural Stepwise Labor Analgesia

目的研究不同浓度罗哌卡因复合舒芬太尼硬膜外阶梯式分娩镇痛的应用价值。方法以2021年11月-2022年11月于莲花县妇幼保健院拟行硬膜外分娩镇痛的60例产妇为研究对象,按照随机数字表法分为A组和B组,每组30例。A组采用0.125%罗哌卡因+0.45μg/ml舒芬太尼镇痛方案,B组采用0.075%罗哌卡因+0.45μg/ml舒芬太尼(产妇宫口<3 cm)联合0.125%罗哌卡因+0.45μg/ml舒芬太尼(产妇宫口≥3 cm)镇痛方案,比较两组疼痛视觉模拟评分(VAS)、血压水平[收缩压(SBP)、舒张压(DBP)]、产程时间(第一产程、第二产程、第三产程、总产程)、下肢肌力情况(Bromage评分)。结果两组宫口<3 cm、宫口≥3 cm、宫口全口及分娩时VAS评分比较,差异无统计学意义(P>0.05);两组镇痛后5 min、镇痛后30 min的SBP、DBP水平低于镇痛前,且A组低于B组(P<0.05);B组第一产程时间及总产程时间短于A组(P<0.05),而两组第二产程、第三产程时间比较,差异无统计学意义(P>0.05);B组Bromage评分优于A组(P<0.05)。结论不同浓度(0.075%+0.125%)罗哌卡因复合舒芬太尼阶段式分娩镇痛可保证良好的镇痛效果,有助于维持产妇血压稳定,缩短产程时间,减少产妇的下肢运动神经阻滞。

Objective To study the application value of different concentrations of ropivacaine combined with sufentanil for epidural stepwise labor analgesia.Methods From November 2021 to November 2022,60 parturients who planned to undergo epidural labor analgesia in Lianhua County Maternal and Child Health Hospital were selected as the research objects.They were divided into group A and group B according to the random number table method,with 30 parturients in each group.Group A was given 0.125%ropivacaine+0.45μg/ml sufentanil for analgesia,and group B was given 0.075%ropivacaine+0.45μg/ml sufentanil(orifice of uterus<3 cm)combined with 0.125%ropivacaine+0.45μg/ml sufentanil(orifice of uterus≥3 cm)for analgesia.The pain visual analogue scale(VAS),blood pressure level[systolic blood pressure(SBP),diastolic blood pressure(DBP)],duration of labor(first stage of labor,second stage of labor,third stage of labor,total stage of labor),and lower limb muscle strength(Bromage score)were compared between the two groups.Results There was no significant difference in VAS scores between the two groups at orifice of uterus<3 cm,orifice of uterus≥3 cm,when the orifice of uterus was fully opened and during delivery(P>0.05).The levels of SBP and DBP at 5 min and 30 min after analgesia in the two groups were lower than those before analgesia,and those in group A were lower than those in group B(P<0.05).The time of the first stage of labor and the total stage of labor in group B were shorter than those in group A(P<0.05),but there was no significant difference in the time of the second stage of labor and the third stage of labor between the two groups(P>0.05).The Bromage score of group B was better than that of group A(P<0.05).Conclusion Different concentrations(0.075%+0.125%)of ropivacaine combined with sufentanil for epidural stepwise labor analgesia can ensure good analgesic effect,help to maintain maternal blood pressure stability,shorten labor time,and reduce maternal lower limb motor nerve block.