舒芬太尼复合罗哌卡因腰硬联合阻滞用于分娩镇痛的临床观察

目的观察腰硬联合阻滞用于分娩镇痛时鞘内分别注射舒芬太尼复合罗哌卡因及单纯罗哌卡因的镇痛效果。方法选择无产科病理性因素及腰硬联合阻滞禁忌的初产妇60例，随机分为A、B组。两组均鞘内注射罗哌卡因3mg，A组给予复合舒芬太尼3μg。硬膜外泵配伍为0．1％罗哌卡因复合0．2μg／mL舒芬太尼，当产妇视觉模拟评分（VAS）≥3分时启用。记录不同时间点两组VAS评分，鞘内注射起效时间及维持时间、罗哌卡因用量、产程情况及不良反应等指标。结果A组鞘内注射起效时间、维持时间及效果均明显优于B组（2．30±0．94）min vs（3．18±1．02）min，t=2．830，P〈0．01；（102．12±11．97）min vs（49．12±11．13）min，t=16．214，P〈0．011，罗哌卡因用量低于B组（33．67±6．01）mg vs（41．60±7．45）mg，t=3．496，P〈0．01]，对产程、新生儿Apgar评分和Bromage评分的影响，两组比较差异无统计学意义（P〉0．05），A组恶心、呕吐及瘙痒发生率高于B组（X^2=25．714。P〈0．05）。结论腰硬联合阻滞用于分娩镇痛蛛网膜下腔注射舒芬太尼复合罗哌卡因起效快、镇痛强、持续时间长、不良反应轻微。

Analgesia effect of combination of Sulfentanyl and Ropivacaine on combined spinal and epidural anesthesia for delivery

Objective To investigate the analgesia effect of combination of Sulfentanyl and Ropivacaine on combined spinal and epidural anesthesia for delivery. Methods A total of 60 primiparas were selected in this study, no maternity pathological factors and no taboo of combined spinal and epidural anesthesia, and randomly divided into two groups. Group A was treated with cavitas subarachnoidealis injection of sulfentanyl 3ug and ropivacaine 3mg, while Group B with ropivacaine 3 mg only .When the VAS≥3, analgesic pump was activted which had 0.1% ropivacaine and 0.2 μg/mL sufentanil. The VAS score, the onset and duration time, ropivacaine consumption, labor, and adverse reactions indicators were compared between the two group. Results Group A showed shorter onset time of analgesia, better analgesia effect,longer maintenance time and less ropivacaine （2.30±0.94）min vs （3.18±1.02）min, t=2.830; （102.12±11.97）min vs （49.12±11.13）min, t =16.214, P 〈 0.05], the dosage of ropivacaine less than grop B （33.67±6.01）mg vs （41.60±7.45） rag, t = 3.496, P 〈 0.05], and no significant different on delivery course, infantile Apgar score and Bromage score （P 〉 0.05）. Nausea, vomiting and pruritus in group A was significantly higher than in group B （X^2=25.714, P 〈 0.05）. Conclusion Combination of sulfentanyl and ropivacaine is of shorter onset time of analgesia , better analgesia effect, longer maintenance time and mild side effect. It is valuable in combined spinal and epidural anesthesia for delivery.