舒芬太尼与芬太尼用于腰硬联合阻滞麻醉分娩镇痛中的临床比较

目的:比较舒芬太尼与芬太尼用于腰硬联合阻滞麻醉分娩镇痛中镇痛效果, 对产程及母婴影响及其副作用。方法: 将180例产妇随机分为三组: 舒芬太尼组(S组)、芬太尼组(F组)、无镇痛组(N组) 各60例。S组和F组镇痛方法均采用腰硬联合阻滞(CSEA) +可控性镇痛(PCA) 模式。镇痛药物S组: 鞘内用舒芬太尼5μg+生理盐水至2 5ml, 硬膜外维持用舒芬太尼0 2μg/ml+0 1%罗哌卡因+生理盐水共100ml。F组: 鞘内用芬太尼20mg+生理盐水至2 5ml, 硬膜外维持用芬太尼1 5mg/ml+0 1%罗哌卡因+生理盐水共100ml。N组不行镇痛, 按产科常规处理。观察镇痛组鞘内给药5、10、30、60、90minVAS评分, 首次加药时间及各组产程时间、分娩方式、产后出血量、催产素使用情况、新生儿娩出后脐静脉血气分析、新生儿Apgar评分等。结果: 三组间产程时间、分娩方式、产后出血量、新生儿窒息发生率无显著性差异。催产素使用镇痛组间比较无显著性差异, 但与无镇痛组有显著性差异。两镇痛组间, 5min和90minVAS评分及首次加药时间有显著性差异, 其余时段两组无显著性差异。结论: 舒芬太尼用于腰硬联合阻滞麻醉分娩镇痛能提供良好的镇痛效果, 与芬太尼相比, 起效更快、镇痛更强、持续时间更长, 且不延长产程, 对母儿均无不良影响, 是一种较理想的分娩?

Clinical comparison of sufentanil and fentanyl used in labor combined spinal - epidural analgesia

Objective:To compare the effect of sufentanil and fentanyl used in labor combined spinal-epidural analgesia (CSCA) and its influence on labor course and mother and infants and its side effects.Methods:180 primiparas were randomly and averagely divided into sufentanil group (S group, intrathecal 5 μg sufentanil plus saline up to 2.5 ml; extradural 0.2 μg/ml sufentanil plus 0.1% ropivacaine and saline up to 100 ml), fentanyl group (F group, intrathecal 20 mg fentanil plus saline up to 2.5 ml; extradural 1.5 mg/ml fentanil plus 0.1% ropivacaine and saline up to 100 ml) and no analgesia group (N group, routine obstetrical treatment without analgesia). Visual analogue score (VAS) at 5 min, 10 min, 30 min, 60 min and 90 min after intrathecal block, the first time for additional analgesia, labor course duration, delivery way, flooding volume, usage of oxytocin, umbilical cord blood gas analysis and neonatal Apgar scores were observed.Results:There were no significant differences in labor course duration, delivery way, flooding volume and incidence of neonatal asphyxia. There were no significant differences in usage of oxytocin between S and F group, but there were significant differences in that comparing to N group. There were significant differences in VAS at 5 and 9 min and the first time for additional analgesia, but no differences at the other time intervals between S and F group.Conclusion:Sufentanil could play a better antalgic role in CSEA, which has the faster action, the stronger effect and the longer duration without prolonged labor course and poor influence on mother and infants comparing to fentanil, be a more perfect analgesia worth clinical popularization and application in obstetrics.