舒芬太尼连续蛛网膜下腔阻滞用于分娩镇痛的可行性  

Feasibility of continuous spinal anesthesia with sufentanil for labor analgesia

作　　者：张宁[1] 徐铭军[1] 

机构地区：[1]首都医科大学附属北京妇产医院麻醉科,北京市100026

出　　处：《临床麻醉学杂志》2013年第3期222-225,共4页Journal of Clinical Anesthesiology

基　　金：北京市卫生局青年科学研究资助项目(QN2009-019)

摘　　要：目的研究舒芬太尼连续蛛网膜下腔阻滞在分娩中应用的可行性。方法选择宫口开大至2～3cm、无椎管内禁忌证、单胎头位初产妇80例,随机均分为连续蛛网膜下腔阻滞组(S组)和腰-硬联合镇痛组(C组)。两组鞘内均推注舒芬太尼8μg(5ml),S组接电子镇痛泵(舒芬太尼1μg/ml),PCA每次2ml,背景剂量2ml/h,锁定时间10min;C组接电子镇痛泵(罗哌卡因1mg/ml+舒芬太尼0.5μg/ml),PCA每次6ml,背景剂量6ml/h,锁定时间10min。记录注药前(镇痛前)、注药后(镇痛后)5、10、15、30、60和120min、宫口开大7～8cm时、宫口开全时的疼痛VAS评分、胎心率(FHR)、宫缩持续时间、宫缩强度。记录镇痛起效时间、首次镇痛维持时间、总镇痛时间、舒芬太尼用量和产程中出现的不良反应及新生儿出生后1、5和10min的Apgar评分。结果两组镇痛后VAS评分均降低,宫口开7～8cm时和宫口开全时,S组VAS评分均明显低于C组(P<0.05)。镇痛起效时间S组明显长于C组(P<0.05),舒芬太尼用量S组明显少于C组(P<0.05);两组产程时间、自然分娩率、镇痛满意率、瘙痒、硬脊膜穿刺后头痛(PDPH)等不良反应差异无统计学意义。结论与传统的硬-腰联合镇痛比较,舒芬太尼连续蛛网膜下隙镇痛用于分娩镇痛虽然起效慢,但维持时间长,效果更确切,对产程影响小。Objective To evaluate the analgesic effects and feasibility of continuous spinal anesthesia with sufentanil for labor analgesia. Methods Eighty nulliparous patients who requested labor analgesia were randomized to receive either continuous spinal analgesia （group S） or combined spinal-epidural analgesia （group C）. All patients were in active labor with a 2-3 em cervical dilatation. In group S, sufentanil 8 μg （5 ml） was given via a spinal catheter followed by patient-controlled analgesia （PCA） with 100 ml of intrathecal sufentanil-only solution at 1 μg/ml, with a basal infusion of 2 ml/h, demand dose 2 ml, and a 10 rain lockout. In group C, patients also received the initial intrathecal 8 μg of sufentanil via a spinal needle, but the PCA solution contained ropivacaine 1 mg/ml and sufentanil 0.5 μg/ml, which was delivered via an epidural catheter, with a basal infusion of 6 ml/h, demand dose of 6 ml, and a 10 min lockout. All injections were stopped when the cervix reached full dilatation. Maternal visual analog scores（VAS） scores, Bromage motor scale, fetal heart rate （FHR）, duration of uterine contraction, intensity of uterine contraction（by fetal heart monitor） and maternal mean arterial blood pressure were monitored before and 5, 10, 15, 30, 60 and 120 min after injection, and at the time points with a 7-8 cm cervical dilatation and full cervical dilatation. Analgesia onset time, total sufentanil dose, reported side effects, and newborn Apgar scores at 1,5 and 10 min after birth were also recorded. Results Analgesia onset time was longer in group S than that in group C （P〈0.05）. The VAS scores were lower in group S than that in group C at 7 8 cm cervical dilation （P〈0.05） as well as at full dilatation （P〈0.05）. Total amount of sufentanil used was also lower in group S than group C （P〈0.05）. Pruritus was similar in both groups. There were no significant difference in labor time, rate of natural childbirth, rate of analgesic satisfaction, itching and post d

关 键 词：舒芬太尼 连续蛛网膜下腔阻滞 产科镇痛 

分 类 号：R614[医药卫生—麻醉学]