不同剂量舒芬太尼Spinocath导管连续蛛网膜下腔阻滞分娩镇痛的临床研究

目的探讨连续蛛网膜下腔注射不同剂量舒芬太尼分娩镇痛的血药浓度与镇痛效果及不良反应的关系。方法选择初产妇90例，随机分为A、B、C3组，每组30例。Spinocath导管连续蛛网膜下腔阻滞，A、B、C3组分别鞘内注射舒芬太尼6μg、8μg和10μg。在镇痛起效时、出现不良反应时及孕妇不良反应消失后分别测定孕妇体内舒芬太尼血药浓度，待孕妇VASI〉3分时启用自控PCA泵维持镇痛，测定新生儿体内舒芬太尼血药浓度。记录镇痛起效时间、首次给药镇痛维持时间、不良反应及运动阻滞情况等。结果舒芬太尼Spinocath导管鞘内给药分娩镇痛时，C组孕妇体内的血药浓度高于A组、B组（P〈0．05），而其不良反应发生率也显著高于A组、B组（P〈0．05）。结论舒芬太尼Spinocath导管连续蛛网膜下腔阻滞时，鞘内首次注射6μg和8μg分娩镇痛效果确切，不良反应少。

Clinical Research on the Different Dosage Sulfentanil in SpinocathCatheter Continuous Spinal Anesthesia for Labor Analgesia

Objective To research the medicine density and analgesic effect and the adverse relation on the different dosage sulfentanil in continuous spinal anesthesia for labor analgesia. Methods 90 pregnant patients were randomly averages divided into 3 groups：group A,group B and group C. Group A were received continuous spinal anesthesia using sulfentanil 6 μg,group B were received continuous spinal anesthesia using sulfentanil 8 μg,group C were received continuous spinal anesthesia using sulfentanil 10 ixg. The blood drug level of sulfentanil were determined at the time the patients took effect, the adverse reaction happened and the adverse reaction disappeared. PCEA was performed when VAS ≥ 3. The sulfentanil blood drug level of the newborn was detected. The effective time, hold up time of analgesic action,the untoward reaction and the situation for blockade were recorded. Results Of patients with sulfentanil in continuous spinal anesthesia for labor analgesia, the medicine density in group C was higher than those in group A and group B （P 〈 0.05 ）, but the incidence rate of adverse reaction was also obviously higher than those in group A and group B （ P 〈 0.05 ）. Conclusion Sulfentanil in spinocath catheter continuous spinal anesthesia for painless labor in the first time injects 6 μg and 8 μg the labor analgesia effect is accurate, and the untoward reaction rate is low.