舒芬太尼用于腰-硬联合分娩镇痛的临床观察

目的:探讨蛛网膜下腔注射复合0.1%甲磺酸罗哌卡因+舒芬太尼0.4μg/ml硬膜外持续镇痛的可行性。方法:选择足月妊娠初产妇80例(ASA I级),自愿分娩镇痛,L2～3间隙腰硬联合穿刺,根据蛛网膜下腔注射不同剂量的舒芬太尼随机分为4组(n=20):对照组舒芬太尼0μg(生理盐水2.5ml),A组舒芬太尼3μg,B组5μg,C组10μg。镇痛起效30min后继续硬膜外持续镇痛,镇痛液均为0.1%甲磺酸罗哌卡因100ml+舒芬太尼40μg,bolus 3ml,持续剂量6ml/h,锁定时间10min(对照组穿刺成功即注入实验及负荷剂量共10ml)。连续监测BP、ECG、sPO2、HR及胎心监测,观察镇痛程度、起效时间、催产素使用率、产妇自我满意度及有关不良反应。结果:各组年龄、身高、体重、产程、催产素使用率、疼痛评分均没有显著性差异(P>0.05)。所有镇痛组对胎心率无明显影响。舒芬太尼各组起效时间明显短于对照组(P<0.01)。对照组和A组分别有4例(20%)、3例(15%)镇痛欠佳(VAS>3),B组与C组均在完全无痛状态下分娩,但C组瘙痒率达70%(P<0.01)。结论:舒芬太尼腰-硬联合分娩镇痛是安全有效的,且以B组(5μg)效果好,不良反应少。

Clinical Investigation of Sufentanil Used in Labor Combined Spinal-epidural Analgesia

Objective： To study the feasibility of subarachnoid injection of sufentanil combined with epidural anesthesia used of 0. 1% ropivacaine mesylate. Methods： 80 cases primipara（ASA I）, who accepted labor analgesia willingly and set lect combined spinal-epidural puncture between L2-3. They were divided into four groups（n = 20）randomly. The control group were treated with sufentanil 0μg（NS 2. 5ml）, group A were treated with 3μg, group B were treated with 5μg, group C were treated with 10μg. After it took effect for 30 minutes, we used 0. 1% ropivacaine mesylate 100ml and sufentanil 40μg, continuous dose 6ml per hour for 10 minutes after bolus 3ml（the control group were injecting experimental dose and loading dose added up to 10rnl as soon as puncturing successfully）. Continuous monitoring BP, ECG. sPO2. HR and fetal heart rate, observing analgesic effect, affect time, the rate of oxvtocin using, maternitu satis- faction and adverst reaction. Results： Of each group, age, height, stage of labor, rate of oxytocin using, pain score test didn＇t note statistical difference（P〉0. 05）. Each group didn＇t have significant on fetal heart rate. Group A, group B and group C＇s affect time were shorter than control group significantly （P〈0. 01）. There were four cases（20%） in control group and three cases（15 % ）in group A were low effective in analgesia, group B and group C were all freed of pain in labor, while the degree of pruritus of group C could reach 70% （P〈0. 01）. Conclusion.. Sufentanil used in labor combined spinal-epidural analgesia is safe and effective, group B were most effeciual and the adverse reaction were lest.