不同间隔时间硬膜外规律间断输注罗哌卡因和舒芬太尼在分娩镇痛中抑制爆发痛的效果比较

目的评价不同间隔时间硬膜外规律间断输注罗哌卡因和舒芬太尼在分娩镇痛中对爆发痛抑制的临床效果。方法有分娩镇痛要求的初产妇60例，随机分为60min组（A组）、75min组（B组）和90min组（C组）。分别规律间断60min、75min、90min单次注射镇痛液6ml，均无背景持续输注剂量。记录VAS、爆发痛、麻醉药物用量、阻滞平面及不良反应发生率等。结果与镇痛前相比，3组产妇在实施分娩镇痛后VAS均降低（P〈0.05），但3组间差异无统计学意义（P〉0.05）。镇痛期间，3组爆发痛发生率比较差异无统计学意义（P〉0．05）；与A组相比，B组与C组罗哌卡因及舒芬太尼用量明显减少（P〈0.05），但B组与C组两组间药物用量差异无统计学意义（P〉0.05）。结论规律间断间隔给药时间自60min延长至75min、90min，麻醉药物用量明显减少，但爆发痛发生率未见明显增加，是一种可行的硬膜外规律间断分娩镇痛注药方式。

Comparison of the inhibition effects of breakthrough pain with regular intermittent epidural bolus injection in different time intervals daring labor analgesia

Objective To evaluate the clinical efficacy of inhibition of breakthrough pain in labor analgesia with regular intermittent epidural bolus injection with ropivacaine and sufentanil in different time intervals. Methods Sixty primiparae who requested labor analgesia were randomized into three groups： group of 60 min （group A）, group of 75 min （group B） and group of 90 min （group C）. All the parturients received regular intermittent epidural injection bolus 6 ml/60 min, 6 ml/75 min and 6 ml/90 min respectively without background continuous infusion dose. VAS, breakthrough pain, the consumption of ropivacaine and sufentanil, blocked segment, and the side- effects were recorded. Results VAS obviously decreased in the three groups since receiving labor analgesia （P〈0. 05）, but no significant difference in VAS was found among the three groups （P〉 0.05）. During labor analgesia, the number of breakthrough pain was similar in the three groups （P 〈0.05）. Compared with group A, the consumptions of ropivacaine and sufentanil in group B and group C were significantly fewer （P〈0.05）, but no significant difference was observed between group B and group C （P〈0.05）. Conclusion Prolonging the interval time from 60 min to 75 min or 90 min, which can reduce the consumption of anesthetics but doesn＇t increase the incidence of break- through pain, is a feasible method for labor analgesia.