舒芬太尼复合罗哌卡因蛛网膜下腔阻滞用于分娩镇痛的可行性

目的研究舒芬太尼复合罗哌卡因蛛网膜下腔阻滞在分娩镇痛中的效果。方法选择首都医科大学附属北京妇产医院2011年1月～2012年10月行蛛网膜下腔阻滞的产妇60例，将其随机分为A组和B组，各30例。A组产妇蛛网膜下腔推注5μg舒芬太尼＋1．5mg罗哌卡因共2．5mL，B组推注罗哌卡因3mg。所有患者连接硬膜外患者自控镇痛（PCA）电子泵。记录镇痛前后的视觉模拟评分（VAS）、胎心率（FHG）、宫缩持续时间等。记录两组镇痛起效时间、镇痛维持时间、产程、缩宫素使用情况、分娩方式及不良反应。结果两组在镇痛后的疼痛VAS评分明显降低（P〈0．05）；镇痛后5min时A组VAS评分明显高于B组（P〈0．05）；当宫VI开至7-8cm、宫口开全时A组VAS评分明显低于B组（P〈0．05）。A组的首次镇痛维持时间明显长于B组（P〈0．05）；两组产程、缩宫素使用情况、分娩方式及瘙痒、恶心呕吐不良反应等比较差异无统计学意义（P〉0．05）。结论与传统的蛛网膜下腔阻滞单纯应用罗哌卡因比较。舒芬太尼复合罗哌卡因蛛网膜下腔阻滞的镇痛效果确切完善，作用持久，不良反应小，值得临床推广。

Feasibility of spinal anesthesia with Sufentanil combined with Ropivacaine for labor analgesia

Objective To evaluate the analgesic effects of spinal anesthesia with Sufentanil combined with Ropivacaine for labor analgesia. Methods 60 mulliparous patients in Beijing Obstetrics ＆ Gynecology Hospital Affiliated to Capital Medical University from January 2011 to October 2012 who were requested spinal anesthesia were randomly divided into group A and group B, with 30 cases in each group. Group A was given via a spinal needle of 5 μg Sufentanil combined with 1.5 mg Ropivacaine, total 2.5 mL. Group B was given via a spinal needle of 3 mg Ropivacaine. All pa- tients were followed by patient-controlled analgesia （PCA） via epidural cather. The visual analog scores （VAS）, fetal heart rate （FHR）, duration of uterine contraction before and after analgesia were recorded. Analgesia onset time, anal- gesic time, stages of labor, conditions of pitocin, delivery mode and side effects were also recorded. Results The VAS scores after analgesia all decreased in both groups （P 〈 0.05）. 5 rain after analgesia, VAS scores in group A was signif- icantly higher than that in group B （P 〈 0.05）, while VAS scores at 7-8 cm cervical dilation, as well as at full dilation in group A were significantly lower than those in group B （P 〈 0.05）. The analgesia duration in group A was significantly longer than that in group B （P 〈 0.05）. There were no significant differences of stages of labor, conditions of pitocin, de- livery mode and side effects such as pruritus, nausea and vomiting between the two groups （P 〉 0.05）. Conclusion Compared with traditional spinal anesthesia with single ropivacaine, the spinal anesthesia of ropivacaine combined with sufentanil for labor analgesia has exact effect, with lasting effect, less side effects, which is worthy of clinical application.