低浓度罗哌卡因联合舒芬太尼椎管内阻滞用于分娩镇痛的效果观察

目的观察低浓度罗哌卡因联合舒芬太尼用于连续硬膜外阻滞（CEA组）与腰硬联合阻滞（CSEA）分娩镇痛的临床效果。方法选择我院正常足月妊娠、均为单胎头位、且无椎管内麻醉禁忌、自愿要求无痛阴道分娩的产妇60例,随机分为三组,即CEA组、CSEA组和对照组（C组）,每组各20例。观察记录三组产妇的镇痛效果、下肢肌力、产程、分娩方式、新生儿Apgar评分。结果 CSEA组和CEA组相对于未进行无痛分娩的C组,产妇的疼痛明显减轻,视觉模拟评分（VAS）明显低于C组（P〈0.01）;CSEA组镇痛起效时间[（44.15±8.61）s]明显快于CEA组[（206.65±35.88）s],CSEA组用药后10、15 min疼痛VAS评分明显低于硬膜外组（P〈0.05）;三组产妇无明显运动阻滞症状,均能下床活动,下肢肌力（Bromage评分）在0～1分（P〉0.05）;三组产妇的产程、分娩方式、新生儿1、5 min Apgar评分等指标比较差异无统计学意义（P〉0.05）。结论低浓度罗哌卡因联合舒芬太尼用于椎管内阻滞分娩镇痛,起效快,镇痛强,对母婴无不良影响,值得临床推广应用。

Effect observation of low concentrations of Ropivacaine combined with Sufentanil in block inside vertebral canal for labor analgesia

Objective To investigate the effect of low concentrations of Ropivacaine combined with Sufentanil in continuous epidural anesthesia（CEA group） and lumbar epidural block childbirth analgesia（CSEA group） for labor analgesia.Methods In our hospital,60 cases with normal full-term pregnancy,single cephalic and spinal anesthesia contraindicated voluntary requirements painless the maternal vaginal delivery were selected and randomly divided into three groups,CEA group,CSEA group and control group（group C）,with 20 patients in each group.The maternal analgesic effect,muscle strength of lower extremities,labor,mode of delivery and Apgar score were observed and recorded.Results Compared with group C,the maternal pain of CSEA group and CEA group was significantly reduced,the VAS score was significantly lower than group C（P 0.01）;the onset time of analgesia of CSEA group was（44.15±8.61） s,significantly faster than（206.65±35.88） s of the CEA group,the pain VAS score after 10 minutes and 15 minutes of medication in CSEA group was significantly lower than the epidural group（P 0.05）;three groups had no obvious symptoms of motor blockable to get out of bed,lower limb muscle strength（Bromage score） in 0 to 1 score（P 0.05）;the maternal labor,mode of delivery,neonatal 1-minute and 5-minute Apgar scores of three groups were compared,the differences were not statistically significant（P 0.05）.Conclusion Low concentrations of Ropivacaine combined with Sufentanil in block inside vertebral canal for labor analgesia is rapid onset,analgesic,and there are no adverse effects on mother and child,it is worthy of clinical application.