低浓度左布比卡因复合舒芬太尼硬膜外分娩镇痛的临床研究

目的探讨低浓度左布比卡因复合舒芬太尼用于硬膜外分娩镇痛的效果及对母婴的影响。方法将自愿要求分娩镇痛的初产妇180例随机均分为3组，每组60例。Ⅰ组用0．125％左布比卡因，Ⅱ组用0．125％左布比卡因＋舒芬太尼0．4μg／mL，组用0．0625％左布比卡因＋舒芬太尼0．4μg／mL。当产妇宫口开至3cm时，L2-3间隙硬膜外穿刺置管，3组硬膜外分别注射各自的注射液5mL，观察5min确认导管在硬膜外腔后追加各自注射液10mL，疼痛视觉模拟评分（VAS）≤3分后行硬膜外自控镇痛（PCEA）。3组自控镇痛（PCA）剂量为2mL，锁定时间为10min，背景剂量为5mL／h。观察镇痛效果、镇痛药物用量、运动阻滞、分娩方式、产程时间、不良反应及新生儿Apgar评分和脐动脉pH。结果与镇痛前比较，3组镇痛期间VAS评分降低（P〈0．05）；镇痛30min，1h，2h，3h收缩压和舒张压均降低（P〈0．05），心率差异无统计学意义（P〉0．05）。与Ⅰ组比较，Ⅱ组产妇镇痛起效时间、PCA有效按压次数和左布比卡因总用量明显降低（P〈0．05）；与I组和Ⅱ组比较，Ⅲ组产妇左布比卡因总用量和催产素使用率下降（P〈0．05）。3组产妇产程时间、胎儿Apgar评分、脐动脉血pH无明显差异（P〉0．05）。结论低浓度左布比卡因混合舒芬太尼硬膜外自控镇痛用于分娩镇痛安全、有效。0．0625％左布比卡因混合舒芬太尼更适合临床需要。

Clinical Study of Low Concentration Levobupivacaine plus Sufentanil for Epidural Labor Analgesia

Objective To investigate the effects of low concentration levobupivacaine plus sufentanil for epidural labour analgesia and its enfluence on parturients and neonates. Methods 180 primiparas demanding for labor analgesia were randomly divided into 3 groups （n=60）.The group Ⅰ used 0. 125% levobupivacaine,the group Ⅱ used 0. 125% levobupivacaine plus sufentanil 0.4 μg/mL and the group Ⅲ used 0. 062 5% levobupivacaine plus sufentanil 0.4 μg/mL. When the cervical dilation to 3 cm,puncture was performed in L2-3 space for indwelling catheter. 3 groups were epidurally injected with 5 mL of respective injection solution. By observing for 5 min, the catheter was verified to be within the epidural space,then 10 mL of respective injection solution was added. If the Visual Analogue Scale（VAS）score ≤3,the patient controlled epidural analgesia（PCEA）was conducted. The dose of the patient controlled analgesia（PCA） in 3 groups was 2 mL with the locking time of 10 min and the background dose of 5 mL/h. The analgesic effect,dosasge of analgesic drugs, motor block, mode of delivery, delivery process time, adverse reactions, neonatal Apgar score and umbilical artery pH value were observed. Results Compared with before analgesia, the VAS scores during analgesia process in 3 groups were significantly reduced （P 〈 0. 05）. At the timepoints of analgesia 30 min,1 h,2 h,3 h,the systolic blood pressure and the diastolic blood pressure were de- creased（P 〈 0.05）,the difference of the heart rate showed no statistical significance（P 〉 0.05）. Compared with the group I,the onset time of analgesia,PCA effective pressing times and the total dosage of levobupivacaine in the group Ⅱ were significantly decreased（P 〈 0. 05）. Compared with the group Ⅰ and Ⅱ, the total dosage of levobupivacaine and oxytocin usage rate in the group Ⅲ were significantly de- creased（ P 〈 0. 05）. There was no significantly differences in the length of labor,fetal Apgar score and umbilical artery pI-I value（P 〉 0. 05）. Conclusion PCEA with low concentration levobupivacaine plus sufentanil is safe and effective in labor analgesia. 0. 062 5% levobupi- vacaine mixed with sufentanil is more suitable for clinical needs.