蛛网膜下腔使用舒芬太尼联合硬膜外腔运用罗哌卡因进行分娩镇痛的研究

目的:探讨蛛网膜下腔使用舒芬太尼,联合硬膜外腔运用罗哌卡因进行分娩镇痛的有效性和安全性。方法:选择ASAI-II级的健康产妇80名,随机分为两组,S组(蛛网膜下腔-硬膜外联合镇痛组)和E组(硬膜外镇痛组)。S组在蛛网膜下腔注射舒芬太尼5μg(2 ml),硬膜外腔给予0.15%罗哌卡因5 ml。E组单纯在硬膜外腔给予0.15%罗哌卡因和5μg舒芬太尼混合液5 ml。30分钟后,用0.125%罗哌卡因行病人自控硬膜外镇痛(patient-controlled epidural analgesia,PECA),维持量为6ml/h。分别于镇痛前、给药后5分钟、10分钟、20分钟、30分钟、60分钟行疼痛视觉模拟评分(visualanalogue scale,VAS)和运动神经阻滞分级(采用改良Bromage分级法测定),记录产妇的镇痛起效时间、罗哌卡因用量、镇痛不良反应、镇痛满意程度以及血压、心率、产程、分娩方式、催产素使用量、新生儿Apgar评分。同时行宫缩和胎心监测。结果:镇痛期间两组的VAS评分降低(P<0.01),镇痛效果满意。S组的镇痛起效时间明显短于E组(P<0.01)。所有产妇的Bromage评分均为0分。产程、催产素使用量、新生儿Apgar评分也没有明显差异(P>0.05)。S组产妇的5分钟和10分钟时血压有一定的下降(P<0.05),出现的皮肤瘙痒明显多于E组(P<0.01),但均为轻度,无须特殊处理。两组各一名产妇改行剖腹产,其原因均为胎儿宫内窘迫,与分娩镇痛无直接关联。结论:蛛网膜下腔使用舒芬太尼,联合硬膜外腔运用罗哌卡因可以快速、有效地进行分娩镇痛。

THE EFFICACY AND SAFETY OF THE COMBINED INTRATHECAL SUFENTANYL AND EPIDURAL ROPIVACAINE FOR LABOR ANALGESIA

Objective: To observe the efficacy and safety of the combined spinal sufentanyl and epidural ropivacaine for labor analgesia.Methods: 80 parturients(ASAI-II) were randomly divided into two groups: group S(n = 40) received combined spinal-epidural analgesia;group E(n = 40) received epidural analgesia.Intrathecal sufentany 5 μg diluted to 2 ml,followed by epidural 0.15% ropivacaine 5 ml.Group E received epidural 0.15% ropivacaine 5 ml plus sufentany 5 μg.Patient-controlled epidural analgesia(PECA) started 30 minutes later.The PCEA solution consisted of 0.125% ropivacaine.The background infusion was 6 ml/h.The following data was recorded at times 0,5,10,20,30 and 60 minutes: motor block using the modified Bromage scale,visual analogue scale(VAS),the onset of the analgsia,the dose of ropivacaine,side effect,maternal satisfaction,maternal vital signs,fetal Apgar score.Fetal heart rate and uterine contraction were monitored continuously.Results: Compare to before analgesia,VAS scores were significantly reduced after analgesia in both groups.Parturients were satisfied with analgesia.In this study,we found the onset of analgesia in the group S was significantly shorter than the group E(P < 0.01).No motor block occurred during the study.There was no significant difference in duration of the stages of labor,oxytocin consumption,fetal Apgar scores(P > 0.05).In group S,the blood pressure was slightly decreased at the point of 5 min and 10 min(P < 0.05),and the incidence of pruritus was significantly higher in group S than that in group E(P < 0.01).But both were slight,and not necessary to treat.One parturients per group selected cesarean birth because of dystocia such as larger baby during the study.There was no relationship between cesarean and labor analgesia in this study.Conclusion: Combined intrathecal sufentanyl and epidural ropivacaine providesd rapid,satisfied and safe labor analgesia.