舒芬太尼对罗哌卡因腰椎与硬膜下联合阻滞分娩镇痛的影响

目的观察舒芬太尼与罗哌卡因腰椎与硬膜下联合阻滞用于分娩镇痛的效果及安全性。方法选择美国麻醉医师协会（ASA）Ⅰ-Ⅱ级、单胎头位、足月初产妇60例，采取抽签法随机分为舒芬太尼组、芬太尼组、对照组各20例，舒芬太尼组蛛网膜下腔注入0．1％罗哌卡因2．5mg＋舒芬太尼4μg共2．5ml，硬膜外腔配置0．1％罗哌卡因＋舒芬太尼0．4μg／ml至50ml行患者自控镇痛（PCA）；芬太尼组蛛网膜下腔注入0．1％罗哌卡因2．5mg＋芬太尼20μg共2．5ml，硬膜外腔配置0．1％罗哌卡因＋芬太尼2μg／ml加生理盐水至50ml行PCA；对照组蛛网膜下腔注入0．1％罗哌卡因2．5mg，硬膜外腔配置0．1％罗哌卡因2．5ml硬膜外腔配置0．1％罗哌卡因生理盐水至5Tnl行PCA。观察并记录镇痛前后产妇生命体征变化、镇痛效果、Bromage评分、分娩方式、不良反应。结果镇痛前后3组的平均动脉压、心率差异有统计学意义（P〈0．05）；蛛网膜下腔注药后的显效时间，舒芬太尼组（2．1±1．1）min]和芬太尼组（2．5±0．7）]优于对照组（5．5±1．6）min]；舒芬太尼组蛛网膜下腔注药维持时间长于芬太尼组和对照组，差异有统计学意义（P〈0．05），芬太尼组蛛网膜下腔注药维持时间长于对照组（P〈0．05）；舒芬太尼组和芬太尼组的罗哌卡因用药量均分别为（16．5±5．3）mg、（17．8±5．7）mg少于对照组（38．5±8．O）mg（P〈0．05）。结论舒芬太尼可增强罗哌卡因腰硬联合阻滞分娩镇痛的镇痛效应，安全可靠。

Effects of sufentanil and ropivacaine on labor analgesia combined with spinal-epidural anesthesia

Objective To evaluate the effect of Sufentanil on Ropivacaine during labor analgesia combined with spinal-epidural anesthesia. Methods Sixty patients of American Society of Anesthesiologists(ASA) Ⅰ～Ⅱ under monotonous head delivery and full-time spontaneous labor, without obstetric complications and contraindication of intravertebral anesthesia, were randomly assigned to 3 groups. Group Sufentanil used intrathecal solution contai-ning a mixture of 0.1% Ropivacaine 2.5 mg and Sufentanil 4.0 μg and normal saline up to 2.5 ml. The epidural (Patient Controlled Analgesia PCA)solution contained a mixture of 0.1% Ropivacaine and Sufentanil 4 μg/ml. Group Fentanyl used intrathecal solution containing a mixture of 0.1% Ropivacaine 2.5 mg and Fentanyl 20 μg and normal saline up to 2.5 ml, the epidural PCA solution contained a mixture of 0.1% Ropivacaine and Fentanyl 2 μg/ml. Control group used intrathecal solution containing 0.1% Ropivacaine 2.5 ml, meanwhile the epidural PCA solution contained 0.1% Ropivacaine. The physical signs, analgesic effect and Bromage Score of those mater-nity patients before and after analgesic were assessed. The puerperal mode and the untoward effect were evaluated. Results The difference of mean arterial pressure(MAP) and heart rate(HR) before and after analgesic in those groups was significant (P < 0.05);The effectual time after subarachnoid administration in Group Sufentanil and Group Fentanyl were both better than control Group (P < 0.05 ). In group Sufentanil, the active time of subarach-noid administration was longer than Group Fentanyl and control Group (both P < 0.05 ), furthermore Group Fentanyl was longer than control Group(P < 0.05). The dosage of Ropivacaine in Group Sufentanil and Group Fentanyl were both lower than control Group(P < 0.05). Conclusions Sufentanil safely enhancse the analgesia effect of Spinal-Epidural anesthesia with Ropivacaine in labor analgesia.