罗哌卡因与舒芬太尼腰-硬联合分娩镇痛的临床效果  

Clinical efficacy of spinal-epidural combination labor analgesia with ropivacaine and sufentanil

作　　者：董小强 刘明[1] 李宁 常红侠[1] DONG Xiaoqiang;LIU Ming;LI Ning(Department of Anesthesiology,Shangluo Central Hospital,Shangluo 726000,CHINA)

机构地区：[1]商洛市中心医院麻醉科,陕西726000 [2]商洛市中心医院产科,陕西726000

出　　处：《江苏医药》2022年第4期398-401,406,共5页Jiangsu Medical Journal

摘　　要：目的观察罗哌卡因与舒芬太尼腰-硬联合分娩镇痛的临床效果.方法足月单胎产妇95例,随机分为两组.R组48例,蛛网膜下腔单次注入0.1%罗哌卡因3 m L;S组47例,蛛网膜下腔单次注入0.083%罗哌卡因3 mL+舒芬太尼2.5μg.两组均在蛛网膜下腔注药30 min后实施患者自控镇痛(PCA).PCA镇痛泵配方:R组为罗哌卡因97.0 mg+舒芬太尼50.0μg;S组为罗哌卡因97.5 mg+舒芬太尼47.5μg;均用生理盐水稀释至100 mL.记录两组镇痛前(T0)、蛛网膜下腔注药10 min(T1)、30 min(T2)、1 h(T3)、2 h(T4)、宫口开全(T5)、胎儿娩出(T6)时的VAS疼痛评分和改良Bromage运动阻滞评分,记录两组产妇分娩结局和不良反应发生情况.结果与T0时比较,两组产妇在T1~T6时MAP、HR、VAS疼痛评分均降低(P<0.05).T2~T4时,S组VAS疼痛评分均低于R组(P<0.05).分娩镇痛过程中,两组改良Bromage运动阻滞评分均为0分,两组T1~T6时的MAP、HR、SpO2和胎心率均无统计学差异(P>0.05).两组产妇的分娩方式、缩宫素使用量、产后出血量及新生儿出生后Apgar评分比较均无统计学差异(P>0.05).与R组相比,S组各产程持续时间有缩短趋势(P>0.05).S组皮肤瘙痒发生率高于R组(14.9%vs.2.1%)(P<0.05).结论罗哌卡因与舒芬太尼的两种复合方式腰-硬联合分娩镇痛总体效果相当;从蛛网膜下腔开始两药复合的用药方式短期镇痛效果较好,但增加皮肤瘙痒发生率.Objective To observe the clinical efficacy of spinal-epidural combination labor analgesia with ropivacaine and sufentanil.Methods Ninety-five full-term puerperants were randomly divided into two groups.Subarachnoid space injection of 0.1% ropivacaine 3 mL was performed in group R(48 cases) and that of 0.083% ropivacaine 3 mL and sufentanil 2.5 μg was performed in group S(47 cases).Epidural PCA started 30 minutes after subarachnoid space injection in groups of R and S.The analgesic solution for epidural PCA in group R consisted of ropivacaine 97.0 mg and sufentanil 50.0 μg in normal saline 100 mL in group R,which in group S consisted of ropivacaine 97.5 mg and sufentanil 47.5 μg in normal saline 100 mL.The VAS pain score and modified Bromage motor block score of two groups were recorded at the time points of before analgesia(T0),10 minutes(T1),30 minutes(T2),1 hour(T3),and 2 hours(T4) after subarachnoid injection, during dilation of the cervix(T5) and fetus delivery(T6).The delivery outcomes and adverse responses of two groups were recorded.Results Compared with T0,the MAP,HR,and VAS pain scores of two groups were decreased at T1-T6(P<0.05).The VAS pain scores at T2-T4 in group S were lower than those in group R(P<0.05).During labor analgesia, the modified Bromage motor block scores of both groups were zero.There were no significant differences in MAP,HR,SpO_(2) and fetal heart rate between the two groups at the same time point(P>0.05).There were no significant differences in the mode of delivery, the amount of oxytocin used, the amount of postpartum hemorrhage and the Apgar score of newborns between the two groups(P>0.05).Compared with group R,the duration of each labor stage in group S was slightly shorter(P>0.05).The incidence of skin pruritus in group S was higher than that in group R(14.9% vs.2.1%)(P<0.05).Conclusion The overall efficacy of above two combinations spinal-epidural combination labor analgesis is similar.The short-term analgesic effect is better when two drugs are used in combination starting

关 键 词：腰-硬联合分娩镇痛 罗哌卡因 舒芬太尼 

分 类 号：R614[医药卫生—麻醉学]