摘要
目的比较不同剂量罗哌卡因联合舒芬太尼蛛网膜下腔注射分娩镇痛的效果。方法单胎头位足月初产妇240例,随机分为3组(n=80):罗哌卡因1.50 mg组、罗哌卡因1.75 mg组、罗哌卡因2.00 mg组。于L2～3行腰硬联合阻滞,蛛网膜下腔注射相应剂量舒芬太尼,硬膜外腔置管,接硬膜外自控镇痛(PCA)泵。记录起效时间、首次用药持续时间、蛛网膜下腔给药后VAS评分、局麻药总量、运动阻滞、各产程时间、分娩方式及产前宫缩素使用。整个产程持续监测胎心、宫缩、血压、血氧饱和度、新生儿1 min、5 min、10min Apgar评分与不良反应。结果 3组均获得良好的镇痛效果。罗哌卡因1.75 mg组、罗哌卡因2.00 mg组维持时间长,与1.50 mg组比较差异有统计学意义(P<0.05);2.00 mg罗哌卡因组阴道器械助产率、产前宫缩素使用率比1.50 mg组、1.75 mg组高(P<0.05)。各产程时间、新生儿Apgar评分、各组间差异无统计学意义(P>0.05)。结论罗哌卡因1.50 mg、1.75 mg、2.00 mg联合舒芬太尼5μg蛛网膜下腔注射分娩镇痛均安全、有效,尤以罗哌卡因1.75 mg、舒芬太尼5μg联合更佳。
Objective To study the efficacy and safety of subarachnoid Space analgesia with different doses of ropivacaine combined with sufentanil during labor.Methods 240 cases of single cephalic primiparas were randomly divided into three groups（n=80）：eighty patients were received intrathecal ropivacaine 1.50 mg,1.75 mg,2.00 mg and 5 μg sufentanil in L2-3 row.An epidural catheter was then placed for patient-controlled epidural analgesia（PCEA）.The onset and duration of ropivacaine analgesia,VAS scores,local anesthetic dose motor block,birth process time,Mode of delivery,Use of prenatal contractions,Across the stage of continuous fetal heart monitor,uterine contractions and blood pressure,blood oxygen saturation,1,5,10 min Apgar scores of neonates and adverse reactions of patients were recorded respectively.Results Good analgesic effects were obtained in all three analgesic groups.In group 1.75 mg and group 2.00 mg,the onset of analgesia were faster,the anesthetic duration of first dosage was longer,the total dose of ropivacaine was lower,and motor block case was less compare with group 1.50 mg（P0.05）,group 2.00 mg prenatal contractions of vaginal instrumental delivery rate,prime rate was higher than the group 1.50 mg,1.75 mg（P0.05）.But there was no significant difference in above index between group 1.75 mg and group 2.00 mg.There were no statistic differences in the duration of labor process,Apgar scores of neonates.Conclusion Subarachnoid analgesia（ropivacaine 1.50,1.75,2.00 mg＋sufentanil 5 μg） can offer safety and efficacy of labor analgesia.Intrathecal ropivacaine 1.75 mg and sufentanil 5 μg was the best combination for labor analgesia.
出处
《中华全科医学》
2013年第3期367-369,共3页
Chinese Journal of General Practice
