低浓度罗哌卡因联合舒芬太尼腰硬联合阻滞用于分娩镇痛的临床效果观察

目的观察低浓度罗哌卡因联合舒芬太尼腰硬联合阻滞（CSEA）用于分娩镇痛的临床效果，探讨其可行性、对母婴的影响及不良反应。方法选择足月单胎妊娠初产妇60例，随机分为观察组和对照组各30例。观察组宫口开大至3cm时行L3-4腰椎穿刺术，蛛网膜下腔注入舒芬太尼5μg，硬膜外腔向头侧置管3．5cm，硬膜外腔接病人自控镇痛泵（PCEA）。硬膜外腔用药：0．1％盐酸罗哌卡因＋0．2μg／ml舒芬太尼混合液，总量100ml。对照组按常规处理未用任何镇痛药。观察镇痛后5、10、30、60和90minVAS评分、各产程时间、新生儿Apgar评分、分娩方式、镇痛效果满意度及不良反应。结果观察组用药后各时点VAS评分低于对照组（P〈0．01）；两组各产程、产后出血差异无统计学意义（P〉0．05）；观察组正常分娩率低于对照组（P〈0．01），缩宫素使用率高于对照组（P〈0．05），但两组机械助产率和剖宫产率差异无统计学意义（P〉0．05）；两组新生儿Apgar评分差异无统计学意义（P〉0．05）；观察组镇痛效果满意度优于对照组（P〈0．01）；观察组出现皮肤瘙痒2例，两组均出现恶心1例，下肢麻木感1例。结论低浓度罗哌卡因联合舒芬太尼腰硬联合阻滞用于分娩镇痛，镇痛效果确切，具有起效快、镇痛强、持续时间长等优点，虽然会增加缩宫素使用率，但并不增加剖宫产率，对母婴无不良影响。

Effect analysis on low concentration of ropivacaine combined with sufentanil combined spinal epidural analgesia in childbirth

Objective To observe the effect of low concentration of ropivacaine combined with sufentanil combined spinal epidural anesthesia（CSEA） for labor analgesia, and discuss its feasibility, effects on mothers and adverse reaction. Methods Sixty pregnant women were randomly divided into the observation group and the control group with 30 cases in each group. In the observation group, when uterine neck opened about 3 cm, the L3-4 lumbar puncture was pertormed, and 5 μg sufentanil was injected into subarachnoid, the tube was placed cephalad into epi- dural cavity until 3.5 cm depth, epidural cavity was connected with a patient-controlled analgesia （PCA） pump. CSEA was performed using a mixture of 0. 1% hydrochloric acid ropivacaine with 0.2 μg/ml of sufentanil adminis- tered in epidural cavity, in total 100 ml. The control group received routine treatment and did not use any analgesics. At 5, 10, 30, 60 and 90 min after analgesia VAS score, the duration of labor, mode of delivery, neonatal Apgar score, analgesic effect degree of satisfaction and adverse reaction were observed. Results VAS score between two groups had statistically significant difference. VAS score in observation group was lower than that in control group. Between two groups, the difference in the birth process, and postpartum hemorrhage were not statistically signifi- cance. Normal birth rate in the observation group was lower than that in control group（P 〈0. 01 ）, the rate of using oxytocin in the observation group was higher than that in the control group（P 〈 0. 05）. The difference in mechanical delivery rate and cesarean section rate, neonatal Apgar score had not statistically significance between the two groups. Analgesia effect degree of satisfaction in observation group was better than that in the control group. Two cases withitch of skin were found in observation group, 1 case with nausea and 1 cases with lower limb numbness in each group. Conclusion Low concentration of ropivacaine combined with sufentanil combined spinal epidural analgesia in child- birth had obvious effect and a long time of analygesia and its effect was quick. Although it will increase the rate of u- sing oxytocin, but not affect the rate of cesarean section, with no harmful effects on mother and infant.