不同剂量舒芬太尼腰硬联合阻滞对分娩镇痛效果及产程的影响  

Effect of different doses of sufentanil on labor analgesia and labor with combined spinal-epidural block

作　　者：田节印[1] 胡明灿[1] 

机构地区：[1]河北邯郸市第一医院东院区麻醉科室,河北邯郸056002

出　　处：《中南药学》2015年第9期999-1002,共4页Central South Pharmacy

摘　　要：目的分析不同剂量舒芬太尼腰硬联合阻滞对分娩镇痛效果以及产程的影响并探讨其最适剂量,以指导临床用药。方法选取2013年1月-2014年9月来本院进行分娩的健康初产妇（ASAⅠ-Ⅱ级）200例,将患者随机分为5组,每组40例,舒芬太尼给药剂量分别为2、4、6、8和10μg,编号为A、B、C、D、E组,各组给药方式均为蛛网膜下腔联合硬膜外镇痛,硬膜外给药初始剂量相同。观察5组孕妇的产程时间、镇痛效果、各时间点的视觉模拟评分（VAS评分）、分娩结局。结果 5组在活跃期、第2产程、第3产程、总产程时间及妊娠结局上,差异无统计学意义（P〉0.05）。5组给药后均获得较好的镇痛效果,与给药前相比,10、15、30、60、90 min时的VAS评分显著下降（P〈0.05）。A组镇痛起效时间明显比其他组长,而维持时间则较其余组短（P〈0.05）。给药后10、15、30 min,B、C、D、E组镇痛效果明显优于A组（P〈0.05）,但60、90 min时各组VAS评分差异无统计学意义（P〉0.05）。皮肤瘙痒是主要不良反应,发生率32%-45%,各组间差异无统计学意义（P〉0.05）。结论舒芬太尼腰硬联合阻滞对分娩镇痛有良好的效果,剂量以4-8μg为宜。综合多种因素,舒芬太尼4μg是行腰硬联合阻滞分娩镇痛较理想的剂量。Objective To analyze the effect of different doses of sufentanil on labor analgesia and labor with combined spinal-epidural block and explore the optimal dose. Methods Totally 200 healthy primiparas（ASA Ⅰ-Ⅱ, single birth） from Jan. 2013- Sep. 2014 were randomly divided into 5 groups（40 in each group）. The dosage of sufentanil was 2, 4, 6, 8 and 10 μg for group A, B, C, D and E. The drug delivery was combined spinal-epidural analgesia, and the initial dose was the same. The labor time, analgesic effects and visual analogue scale（VAS score） of each point and childbirth outcome of the 5 groups were observed. Results The active period, the second stage of labor, the third stage of labor, total process time and pregnancy outcomes of the 5 groups were similar（P〈0.05）. All the 5 groups had good analgesia effect after the treatment. VAS declined gradually 10, 15, 30, 60 and 90 min after the injection compared with that before the injection in the 5 groups（P〈0.05）. The onset time of subarachnoid analgesia in group A was significantly longer than the other groups, while the duration was shorter than that of the rest groups（P〈0.05）. 10, 15, 30 min after the treatment, B, C, D, E group analgesic effect were better than group A（P〈0.05）. At 60 and 90 min, the VAS score of each group was not significantly different（P〈0.05）. The main adverse reaction was pruritus, the utilization rate of pruritus in the 5 groups was 32%- 45%, and the difference among groups was not statistically significant（P〈0.05）. Conclusion Intrathecal sufentanil（4- 8 μg） combined spinal-epidural labor can have better analgesic effect, and the ideal dose is 4 μg.

关 键 词：舒芬太尼 腰硬联合阻滞 分娩镇痛 剂量 产程 

分 类 号：R714.3[医药卫生—妇产科学]