上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (4): 499-.doi: 10.3969/j.issn.1674-8115.2012.04.027

• 论著（临床研究） • 上一篇    下一篇

椎管内不同诱导方式下舒芬太尼复合罗哌卡因用于分娩镇痛的临床观察

李海冰, 刘志强, 陈秀斌, 马馨霞, 宦 嫣   

  1. 同济大学附属第一妇婴保健院麻醉科, 上海 200040
  • 出版日期:2012-04-28 发布日期:2012-04-27
  • 通讯作者: 刘志强, 电子信箱: jinqiliu@sohu.com。
  • 作者简介:李海冰（1971—）, 男, 主治医师, 硕士；电子信箱: hiblee@163.com。

Clinical efficacy of diverse intravertebral infusion with sufentanil and ropivacaine for labor analgesia

LI Hai-bing, LIU Zhi-qiang, CHEN Xiu-bin, MA Xin-xia, HUAN Yan   

  1. Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 200040, China
  • Online:2012-04-28 Published:2012-04-27

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摘要：

目的 比较椎管内不同诱导方式下腰-硬联合阻滞（CSEA）或硬膜外阻滞（EA）中，相同浓度的舒芬太尼复合罗哌卡因用于分娩镇痛的临床效果。方法 自愿接受分娩镇痛足月、单胎和头位初产妇60例，宫口扩张3 cm时随机分为CSEA组和EA组，每组30例；另设无分娩镇痛的30例产妇为对照组。CSEA组鞘内注射舒芬太尼5 μg后硬膜外置管接自控镇痛（PCA）；EA组硬膜外注射0.1%罗哌卡因与0.5 μg/mL的舒芬太尼混合液实验剂量5 mL，随后注入上述药物10 mL后再接PCA；对照组未行任何镇痛处理。观察CSEA组和EA组的镇痛起效时间、镇痛完善时间、产妇满意度、不良反应、各产程时间、剖宫产率、催产素及器械助产的使用情况。结果 实施椎管内麻醉后，CSEA组和EA组的视觉疼痛评分表（VAS）评分逐渐降低。CSEA组的镇痛起效时间和镇痛完善时间较EA组显著提前。CSEA组和EA组的活跃期较对照组显著缩短（P<0.05）；EA组第二产程较CSEA组和对照组延长（P<0.05）；3组间第三产程时间的差异无统计学意义（P>0.05）。CSEA组皮肤瘙痒发生率高于EA组和对照组。EA组改良Bromage评分高于CSEA组和对照组；3组剖宫产率、催产素及器械助产率差异无统计学意义（P>0.05）。结论 舒芬太尼-罗哌卡因用于CSEA和EA均能提供满意且安全的分娩镇痛。CSEA因具有起效快、药物用量少和产妇满意度高的优点而更适合用于分娩镇痛。

关键词: 腰-硬联合阻滞, 硬膜外阻滞, 分娩镇痛, 舒芬太尼, 罗哌卡因

Abstract:

Objective To compare the clinical efficacy of combined spinal-epidural analgesia (CSEA) and epidural analgesia (EA) with sufentanil and ropivacaine for labor. Methods Sixty nulliparous parturients with cervical dilation of 3 cm were randomly assigned to receive CSEA (CSEA group) or EA (EA group) for labor, with 30 parturients in each group. Another 30 nulliparous parturients without labor analgesia were served as control group. Sufentanil 5 μg was intrathecally injected in every parturient of CSEA group, and was followed by administration of patient controlled analgesia (PCA). For EA group, 0.1％ropivacaine 5 mL in combination with 0.5 μg/mL sufentanil was administered, which was followed by injection of additional 10 mL, and PCA was applied. No analgesia was performed to control group. The analgesic onset time, maximum effect time, satisfaction from parturients, side effects, duration of stages of labor, cesarean section rate, and oxytocin and instrumental delivery were observed. Results The scores of visual analogue scale (VAS) in CSEA group and EA group gradually decreased after intravertebral anesthesia. The analgesic onset time and maximum effect time of CSEA group significantly advanced than EA group. The active periods of CSEA group and EA group were significantly shorter than that in control group (P<0.05). The duration of second stage of labor of EA group was longer than those of CSEA group and control group (P<0.05). There was no significant difference in the duration of the third stage of labor among three groups (P＞0.05). The prevalence of pruritus of CSEA group was higher than those of EA group and control group. The modified Bromage score of EA group was higher than those of CSEA group and control group. There was no significant difference in the cesarean section rate, oxytocin and instrumental delivery rate among three groups (P＞0.05). Conclusion CSEA and EA with sufentanil and ropivacaine are effective and safe for labor. CSEA is more suitable for labor with faster onset, lower consumption of drug and higher rate of satisfaction from parturients．

Key words: combined spinal-epidural analgesia, epidural analgesia, labor analgesia, sufentanil, ropivacaine