舒芬太尼联合罗哌卡因用于分娩镇痛的临床研究

目的观察舒芬太尼联合罗哌卡因在分娩镇痛中的应用效果及对产程、新生儿的影响。方法自愿要求实施分娩镇痛的初产妇160例随机分成两组，A组和B组各80例，并抽取同期住院分娩不愿镇痛的初产妇80例为对照（C组），A组采用硬膜外腔持续注射舒芬太尼0．2μg／ml＋0．1％罗哌卡因溶液100ml；B组于蛛网膜下腔注射罗哌卡因1．5mg＋5％葡萄糖注射液共2ml；C组未采取镇痛措施。观察三组镇痛效果、运动神经阻滞、产程时间、分娩方式、产后出血量、新生儿Apgar评分等情况。结果A组和B组镇痛后各时点VAS评分均较C组明显降低（均P〈0．01）；A组5min、10min、30min各时点的VAS评分分别为（3．4±1．2）、（1．6±0．7）、（0．7±0．5）分，与B组的（5．3±1．5）、（4．3±1．8）、（3．1±1．7）分相比较，差异均有统计学意义（均P〈0．01），三组第一产程时间、剖宫产率、器械助产率、产后出血量、新生儿Apgar评分、运动神经阻滞等方面比较，差异均无统计学意义（均P〉0．05）。结论舒芬太尼联合罗哌卡因用于分娩疼痛，不延长产程，无明显不良反应，是一种较为理想的分娩镇痛方法，值得推广应用。

Clinical study of sufentanil and ropivacaine used in labor combined spinal-epidural analgesia

Objecttve To investigate the effects of snfentanil and ropivacaine used in labor combined spinalepidural analgesia(CSEA)and its influence on labor course and infants and its side effects.Methods 160 primiparas who chose deliver analgesia were randomly divided into two groups:group A intrathecal 5μg sufentanil plus saline up to 2.5ml,extradural 0.2μg/ml sufentanll plus 0.1% ropivacaine and saline up to 100 ml;group B extradural ropivacaine 1.5mg plus glucose 100g/L up to 2ml;group C have no analgesia.Then to investigate the effects of analgesia VAS scores,labor course duration,caesarean section rate,flooding volume,neonatal Apgar scores and its side effects.Results Compared with group C,the analgesia effects of group A and B were definitely(P＜0.05,P＜0.01);visual analogue score(VAS)at 5min,10min and 30min in group A were(3.4±1.2),(1.6 ±0.7)and(0.7 ±0.5)respectively,while in group B were(5.3±1.5),(4.3±1.8)and(3.1±1.7),which had significant difference in two groups(all P＜0.01);they all could reduce the first labor course duration,caesarean section rate,and there were no difference with group C(P＞0.05);and the flooding volume and neonatal Apgar scores had no differences(P＞0.05).Conclusion Sufentanil and ropivacaine combined used in CSEA has stronger effect and longer duration without prolonged labor coulee and poor side effects,which would be a more perfect analgesia worth clinical application in obstetrics.