不同剂量舒芬太尼联合罗哌卡因鞘内注射分娩镇痛临床研究

目的比较不同剂量舒芬太尼联合罗哌卡因鞘内注射分娩镇痛的效应。方法单胎头位足月初产妇60例,随机分为三组（n=20）：舒芬太尼3μg组、舒芬太尼5μg组、舒芬太尼7μg组。于L2-3行腰硬联合阻滞,鞘内注射相应剂量舒芬太尼以及2mg罗哌卡因,硬膜外腔置管,接硬膜外自控镇痛（PCA）泵。记录起效时间、首次用药持续时间、鞘内给药后VAS评分、局麻药总量;运动阻滞、各产程时间、新生儿1min和5min Apgar评分与不良反应。结果三组均获得良好的镇痛效果。舒芬太尼5μg、7μg组起效快、维持时间长,与3μg组比较差异有统计学意义（P〈0.05）;3μg组罗哌卡因总量、运动阻滞例数比5μg、7μg组明显增加（P〈0.05）。但上述指标5μg、7μg组之间无差异。各产程时间、新生儿Apgar评分、瘙痒发生率各组间差异无统计学意义（P〉0.05）。结论舒芬太尼3μg、5μg、7μg联合罗哌卡因2mg鞘内注射分娩镇痛均安全、有效,但综合评估鞘内注射分娩镇痛联合用药以舒芬太尼5μg联合罗哌卡因2mg更佳。

Subarachnoid-epidural analgesia with different doses of sufentanil combined with ropivacaine during labor

Objective To study the efficacy and safety of subarachnoid-epidural analgesia with different doses of sufentanil combined with ropivacaine during labor.Methods Sixty patients were received intrathecal sulfentanil 3μg,5μg,7μg and 2 mg ropivacaine randomly.An epidural catheter was then placed for patient-controlled epidural analgesia（PCEA）.The onset and duration of subarachnoid analgesia,VAS scores,local anesthetic dose,motor block,birth process time,1,5min Apgar scores of neonates and adverse reactions of patients were recorded respectively.Results Good analgesic effects were obtained in all three analgesic groups.In group 5μg and group 7μg,the onset of analgesia were faster,the anesthetic duration of first dosage was longer,the total dose of ropivacaine was lower,and motor block case was less compare with group 3μg（P 0.05）,but there was no significant difference in above index between group 5μg and group 7μg.There were no statistic differences in the duration of labor process,Apgar scores of neonates.The rate of obstetric forceps and the rate of caesarean section of patients were low and no statistic differences.Conclusion Subarachnoid analgesia（sufentanil 3,5,7μg ＋ ropivacaine 2mg） can offer safety and efficacy of labor analgesia.Intrathecal sufentanil 5μg and ropivacaine 2mg is the best combination for labor analgesia.