Spinocath导管鞘内连续给药和腰硬联合阻滞分娩镇痛的对照研究

目的:观察Spinocath导管鞘内连续给药和腰硬联合阻滞分娩镇痛的临床应用效果。方法:选择初产妇165例,随机分A组25例,B、C组各70例。A组和B组蛛网膜下腔分别注射8μg及6μg舒芬太尼,待产妇VAS≥3分时启用自控PCA泵维持镇痛;A组鞘内用药为0.4μg/ml的舒芬太尼,B组硬膜外腔用药为0.143%甲磺酸罗哌卡因+0.3μg/ml的舒芬太尼,C组按产科常规处理不给任何镇痛药物。观察A、B组的镇痛起效时间、鞘内首次给药镇痛持续时间、运动阻滞、镇痛满意度等,观察3组的各时间点VAS评分、产程时间、出血量、新生儿Apgar评分、分娩方式、不良反应等。结果:A组鞘内首次给药镇痛持续时间长于B组(P<0.05),A组的产后头痛发生率高达60%。结论:微量舒芬太尼Spinocath导管鞘内连续给药和以舒芬太尼为主要药物的腰硬联合阻滞这两种分娩镇痛方法具有起效快、镇痛效果良好、能缩短产程、运动神经无阻滞、降低剖宫产率、对新生儿无不良影响,Spinocath导管鞘内连续给药分娩镇痛产后头痛发生率高且费用略显昂贵。

A control study on the clinical effects of continuous intrathecal anesthesia with Spinocath duct and combined spinal- epidural anesthesia for labor analgesia

Objective:To observe the clinical application effects of continuous intrathecal anesthesia with Spinocath duct and combined spinal-epidural anesthesia(CSEA) in labor analgesia. Methods:165 primiparous women were selected and divided into group A(25 cases),group B(70 cases) and group C(70 cases) randomly.8 μg and 6 μg sufentanil were injected into subarachnoid space in group A and group B,respectively;when VAS≥3,the cases adopted self-control PCA pump to maintain analgesia;the analgesic drugs used in group A and group B were sufentanil(0.4 μg/ml) and ropivacaine mesylate(0.143%)+sufentanil(0.3 μg/ml),respectively;the cases in group C received conventional obstetrical treatment without any analgesic drugs.The onset times of analgesia,duration times of analgesia after the first intrathecal injection,motor block,satisfaction of analgesia in group A and group B were observed.VAS scores at different time points,the times of labor duration,the amounts of blood loss,neonatal Apgar scores,delivery modes and adverse reactions in the three groups were observed. Results:The duration time of analgesia after the first intrathecal injection in group A was longer than that in group B(P<0.05),the incidence of postpartum headache in group A was as high as 60%. Conclusion:The two methods for labor analgesia including continuous trace amount sufentanil intrathecal anesthesia with Spinocath duct and CSEA with sufentanil as the main analgesic drug have the advantages of quick onset,good analgesic effect,short labor duration,no motor block,low cesarean section rate and no adverse impact on neonates,but the incidence of postpartum headache and the expense are high with the method of continuous trace amount sufentanil intrathecal anesthesia with Spinocath duct.