产妇鞘内注射舒芬太尼分娩镇痛的效应  

Intrathecal sufentanil for labor analgesia in parturients

作　　者：刘继云[1] 佘守章[1] 邬子林[1] 韩光炜[1] 杨美英[2] 邓玲红[2] 

机构地区：[1]广州市第一人民医院麻醉科,510180 [2]广州市第一人民医院产科,510180

出　　处：《中华麻醉学杂志》2005年第10期768-770,共3页Chinese Journal of Anesthesiology

摘　　要：目的产妇鞘内注射不同剂量舒芬太尼分娩镇痛的效应。方法 孕足月的初产妇100 例,ASA I或Ⅱ级,随机分为5组(n=20):舒芬太尼1μg组(A组)、舒芬太尼3μg组(B组)、舒芬太尼 5μg组(C组)、舒芬太尼7μg组(D组)和舒芬太尼10μg组(E组)。L2,3行脊椎-硬联合穿刺,鞘内注射 相应剂量舒芬太尼,硬膜外腔置管,接硬膜外自控镇痛(PCEA)泵。记录鞘内给药前、后产妇血压 (BP)、心率(HR)、呼吸频率(RR)、脉搏血氧饱和度(SpO2)。观察各组镇痛起效时间,应用视觉模拟镇 痛评分(VAS)评估疼痛效果,记录PCEA首次给药时间和总用药量,改良Bromage评分评价双下肢运动 阻滞情况。记录产妇出现不良反应和新生儿出生后1、5 min时Apgar评分。结果 各组年龄、身高、 体重、妊娠时间、宫口扩张程度比较差异无统计学意义(P>0．05)。与A组比较,B～E组镇痛起效时 间缩短,首次PCA给药时间延长,最高感觉阻滞平面上移;C～E组PCA药液总量、PCA按压次数减 少;B～E组鞘内给药后5—30min时有效镇痛率升高(P<0．05或0．01)。各组催产素使用率、分娩出 血量、镇痛满意度、新生儿出生后1、5 min时Apgar评分比较差异均无统计学意义(P>0．05)。D、E组 恶心呕吐、瘙痒、下肢麻木的发生率高于A、B组(P<0．01)。结论 产妇鞘内注射舒芬太尼联合 PECA分娩镇痛是安全、有效的,鞘内注射舒芬太尼的剂量以3～5μg为宜。Objective To compare the safety and efficacy of different doses of intrathecal sufentanil for labor analgesia in parturients. Methods One-hundred ASA Ⅰ or Ⅱ nulliparous parturients at 39-40 weeks of gestation who requested labor analgesia were included in this randomized double-blinded study. They were all in active labor with a 2-3 cm cervical dilatation. The subarachnoid block was performed at L2.3. The patients were randomized to received intrathecal sufentanil 1,3,5,7, or 10 μg. An epidural cather was then placed for patientcontrolled epidural analgesia （PCEA）. The PCEA solution contained 0.1% ropivacaine and sufentanil 0.4 μg· kg^-1. The PCEA settings were as follows： background infusion 5 ml·h^-1 , demand bolus 3 ml and lock-time interval 10 min. Pain relief was assessed by VAS scores, oxytocin dose, maternal satisfaction, hemodynamics and side effects. Apgar scores of the new-borns were recorded. Results Demographic data including age, sex, body weight and baseline VAS were similar among the five dose groups. There were significant differences in the onset , duration and efficacy of analgesia among the five dose groups. Significantly more patients who received 10 μg sufentanil reported nausea and vomiting and pruritus than those who received 1 or 3 μg sufentanil. There was no significant difference in Apgar scores among the 5 dose groups. Conclusion Intrathecal sufentanil combined with PECA is safe and effective for labor analgesia. Intrathecal sufentanil 3-5 μg is the dose of choice for labor pain relief.

关 键 词：舒芬太尼 镇痛 产科 注射 脊髓 

分 类 号：R714.3[医药卫生—妇产科学]