腰麻-硬膜外联合阻滞用于分娩镇痛的药物比较研究

目的:观察3种不同药物用于腰麻-硬膜外联合阻滞(CSEA)分娩镇痛的效果、安全性以及对产程和母婴的影响,以探讨最佳的配伍和药物剂量,为临床分娩镇痛提供指导和借鉴。方法:选择要求分娩镇痛产妇300例随机分为3组:单纯罗哌卡因组(R组)、单纯舒芬太尼组(S组)、罗哌卡因+芬太尼组(RF组);另选择100例未采用任何镇痛方式的产妇作为对照组。观察并记录各组镇痛效能及对产程和母婴的影响。结果:①镇痛3组均获得良好的镇痛效果。RF组与S组起效时间明显短于R组(P<0.01);RF组与S组首剂持续时间明显长于R组(P<0.01);RF组与S组的起效时间和首剂持续时间无显著性差异(P>0.05);RF组局麻药总用量明显少于R组(P<0.01)。②3组镇痛前后各时点产妇的MBP(平均动脉压)、HR(心率)、RR(呼吸频率)、SpO2(血氧饱和度)无显著性差异(P>0.05)。③第一产程活跃期时间,镇痛3组均短于对照组,有显著性差异(P<0.01);第二产程时间及第三产程时间,各组之间无显著性差异(P>0.05);各组之间的器械助产率及剖宫产率无显著性差异(P>0.05)。④新生儿1min及5min Apgar评分,各组之间无显著性差异(P>0.05)。⑤S组有12例、RF组有17例发生皮肤瘙痒,但症状轻微,无需应用拮抗药;其余不良反应的发生率各组之间差异无统计学意义(P>0.05)。结论:3种给药方案均可安全有效应用于分娩镇痛。选择0.15%罗哌卡因复合2μg/ml芬太尼用于腰麻-硬膜外联合阻滞分娩镇痛疗效确切、起效更快、作用时间更长。由于局麻药用量减少,因此,对运动神经的影响更小、不良反应少,产妇易于接受,满意率高,是无痛分娩的一种理想麻醉方法。

Comparison of drug of combined spinal-epidural analgesia for labor pain

Objective:To observe the efficiency and safety for labor pain using combined spinal-epidural analgesia with three drug on mother and fetus, and to find out the best compatibility and dosage of medicine to relief labor pain.Methods:300 parturients were randomized into three experiment groups, including ropivacaine group (group R), sufentanil group (group S) and group of ropivacaine plus fentanyl (group RF). Another 100 delivery woman without any analgesics was chosen as control group. Analgesic effect on mother and newborn were observed and recorded.Results:①Analgesic potency comparison: Good analgesic effects were obtained in all three analgesic groups. The onset of analgesia in group RF and group S were significantly faster than that in group R (P<0.01). The anesthetic duration of first dosage was significantly longer in group PF and group S than that in group R (P<0.01). There was no significant difference between group RF and group S (P>0.05) and the total dose of local anesthetic in group RF was significant less than that in group R (P<0.01). ②The influence on parturients: No significant difference in MBP (mean arterial blood pressure), HR (heart rate), RR (respiration rate), SpO2 (saturation oxygen) were found in all the three experiment analgesic groups measured in various points before and after analgesia (P>0.05).③The influence on the duration of labor process: The first stage in the three analgesia groups was shorter than that in control group (P<0.01). There were no significant differences in the duration of the second and third stage among all of groups. No significant difference was found in all the four groups dealing with the assistance of surgical instruments. ④The influence on newborn: There were no significant difference in 1st min and 5th min Apgar score among the four groups(P>0.05). ⑤The incidence of adverse effects: There were 12 cases in group S and 17 cases in group RF showing skin itch, and no symptom needed to cure. No significant difference of other adverse effects were found among the four groups (P>0.05).Conclusion:All the three of analgesic plans were safe and efficient for labor pain. The group received combined spinal-epidural analgesia with 0.15% ropivacaine plus fentanyl 2 μg/ml showed better labor analgesia, faster onset time, longer duration, less total dose, and lighter motor block, because this combination had less side effects, easier reception for parturients with higher satisfaction rate, being an ideal painless way of labor.