舒芬太尼鞘内给药行腰硬联合阻滞分娩镇痛的剂量探讨  

Exploration of the dosage of intrathecal Sufentanil for labor analgesia combined with spinal-epidural anesthesia

作　　者：晏桂华[1] 王耕[1] 高勇[1] 许桂荣[1] 何永红[1] 陈秀珍[1] 万华[1] 许斌[1] 

机构地区：[1]广西壮族自治区北海市妇幼保健院麻醉科,广西北海536000

出　　处：《中国医药导报》2013年第22期91-93,106,共4页China Medical Herald

摘　　要：目的观察不同剂量舒芬太尼鞘内注射给药行腰硬联合分娩镇痛的效果及对产程的影响,探讨其最适宜剂量。方法 120例健康初产妇(ASAⅠ～Ⅱ级),随机分为Ⅰ、Ⅱ、Ⅲ、Ⅳ组,每组30例。腰穿成功后各组鞘内分别注入舒芬太尼3μg(Ⅰ组)、4μg(Ⅱ组)、6μg(Ⅱ组)、8μg(Ⅳ组),拔针后硬膜外置管接镇痛泵。硬膜外给予初量药物15 min后,当VAS评分≥3分时,启动镇痛泵行硬膜外镇痛。观察镇痛起效时间、持续时间。观察各时间点的视觉模拟评分(VAS评分)、运动阻滞评分、各组产妇产程时间。观察产程中血压(MAP)、脉搏(HR)、血氧饱和度(SpO2),镇痛期间及镇痛后24 h内的不良反应。观察分娩过程中缩宫素使用情况、分娩方式及新生儿出生后1、5 min Apgar评分。结果Ⅰ组起效时间明显长于Ⅱ～Ⅳ组,且Ⅰ组维持时间明显短于Ⅱ～Ⅳ组(P<0.05)。Ⅰ～Ⅳ组产妇鞘内给药后10、15、30、60、90 min的VAS评分均较注药前明显降低(P<0.05),与Ⅰ组比较,Ⅱ～Ⅳ组鞘内给药后10、15、30 min VAS评分明显降低(P<0.05)。缩宫素使用率Ⅰ组43%(13/30)、Ⅱ组45%(15/30)、Ⅲ组75%(20/30)、Ⅳ组80%(24/30)。与Ⅰ组比较,Ⅳ组缩宫素使用率明显增加(P<0.05)。主要不良反应是皮肤瘙痒、心动过缓及头晕。四组产妇皮肤瘙痒均在50%～60%。随着舒芬太尼剂量的增加,皮肤瘙痒症状更严重、持续时间更长。Ⅰ～Ⅳ组心动过缓与头晕发生率为[0(0/30),3%(1/30)],[10%(3/30),13%(4/30)],[13%(4/30),17%(5/30)],[23%(7/30),27%(8/30)]。与Ⅰ组比较,Ⅳ组心动过缓与头晕的发生显著增高(P<0.05)。四组产妇的生命体征、产程、中转剖宫产率、产后出血及新生儿出生后1、5 min Apgar评分比较差异无统计学意义(P>0.05)。结论舒芬太尼4～8μg鞘内给药行腰硬联合阻滞分娩能提供较好的镇痛效果,不影响产程。但活跃期以4～6μg为佳。Objective To explore the optimum dose of intrathecal Sufentanil by observing the effects and the influ ences on parturient of different doses for labor analgesia.Methods 120 cases of healthy primipara（ASA Ⅰ-Ⅱ,single birth）,with 3-4 cm cervical dilatation were randomly divided into group Ⅰ,group Ⅱ,group Ⅲ and group Ⅳ,with 30 cases in each group.Sufentanil 3 μg（group Ⅰ）,4 μg（group Ⅱ）,6 μg（group Ⅲ） and 8 μg（group Ⅳ） were respectively injected into subarachnoid space.An epidural cather was then placed for patient-controlled epidural（PCEA）.After 15 minutes,the initiative dose of local anesthetics were given,the patient controlled epidural analgesia（PCEA） pumps were connected to the epidural cathers and started,when VAS scores of pregnant women were greater than or equal to 3 scores.The PCEA pumps were stopped in all groups when patients uterine cervix dilated to 9 cm.The onset time and duration of subarachnoid analgesia were observed;visual analogue scale（VAS） and Bromage scale were recorded respectively before and 10,15,30,60,90 min after injection;the vital sign,labor stage,labor type,adverse reactions of parturients and the Apgar score at 1,5 min of neonates were recorded respectively.Results The onset time of subarachnoid analgesia in group Ⅰ were faster than that in group Ⅱ,Ⅲ,Ⅳ;the duration of subarachnoid analgesia in group Ⅰ was shorter than that in group Ⅱ,Ⅲ,Ⅳ（P 0.05）.VAS declined gradually 10,15,30,60,90 min after injection compared with before injection in 4 groups（P 0.05）.The utilization rate of oxytocin in group Ⅰ,Ⅱ,Ⅲ,Ⅳ were 43%（13/30）,45%（15/30）,75%（20/30）,80%（24/30） separately.Compared with group Ⅰ,the utilization rate of oxytocin in group Ⅳ was significantly higher.The main adverse reactions were pruritus,heartbeat bradycardia and dizziness.The utilization rates of pruritus of 4 groups were in 50%-60%.With the increase of Sufentanil doses,skin pruritus was more severe,longer duration.The occurrenc

关 键 词：分娩镇痛 舒芬太尼 腰硬联合阻滞 适宜剂量 

分 类 号：R614.2[医药卫生—麻醉学]