摘要
目的比较罗哌卡因、舒芬太尼单独或混合用药连续蛛网膜下腔阻滞用于分娩镇痛的效果。方法选择自愿要求分娩镇痛的初产妇90例，ASA分级Ⅰ或Ⅱ级，年龄23～35岁，身高155～170 cm，在出现子宫规律收缩，进入第一产程后进行分娩镇痛。采用随机数字表法分为3组（n＝30）：罗哌卡因组（R组）、舒芬太尼组（S组）和罗哌卡因混合舒芬太尼组（RS组）。经L3，4行连续蛛网膜下腔穿刺置管。R组注入首剂量罗哌卡因（0.6 mg/ml）5 ml，随后连接电子镇痛泵，输注0.2 mg/ml罗哌卡因；S组注入首剂量舒芬太尼（1.6 μg/ml）5 ml，随后连接电子镇痛泵，输注0.2 μg/ml舒芬太尼；RS组注入首剂量罗哌卡因0.3 mg/ml ＋舒芬太尼0.8 μg/ml混合液5 ml，随后连接电子镇痛泵输注0.1 mg/ml罗哌卡因＋0.1 μg/ml舒芬太尼。3组镇痛泵参数设置：背景输注剂量5 ml/h，锁定时间15 min，PCA剂量5 ml，总容量100 ml。3组注入首剂量后30 min时连接镇痛泵，产后2 h停药。维持VAS评分≤3分。于镇痛前、注入首剂量后5、10和30 min时记录VAS评分。于镇痛前、镇痛0～30 min、30～60 min、90～120 min时段和第二产程记录宫缩间隔时间和持续时间。记录产妇恶心呕吐、瘙痒、侧切、器械助产、剖宫产、硬脊膜穿刺后头痛的发生情况和缩宫素的使用情况。出生后1、5、10 min时记录新生儿Apgar评分。结果3组新生儿出生后1、5、10 min时Apgar评分均≥7分。与镇痛前比较，R组镇痛0～30 min时宫缩间隔时间延长，持续时间缩短（P〈0.05），S组和RS组镇痛各时段宫缩间隔时间和持续时间差异无统计学意义（P〉0.05）。与R组比较，S组和RS组注入首剂量后5、10 min时VAS评分升高，镇痛0～30 min时宫缩间隔时间缩短，持续时间延长，S组瘙痒发生率升高（P〈0.05或0.01）；与S组比较，RS组瘙痒发生率降低（P〈0.01），各时点VAS评分、各时段宫缩间隔时间和宫缩持续时间比较差异无统计学意义（P〉0.05）。结论罗哌卡因混合舒芬太尼连续蛛网膜下腔阻滞用于分娩镇痛的效果优于两者单独应用。
ObjectiveTo compare the continuous subarachnoid block with ropivacaine or sufentanil either alone or in combination for labor analgesia.MethodsNinety nulliparous parturients who required labor analgesia voluntarily, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 23-35 yr, with a body height of 155-170 cm, were included in this study.When regular uterine contraction appeared, labor analgesia was performed in the first stage of labor.The parturients were divided into 3 groups（n=30 each）using a random number table： ropivacaine group（group R）, sufentanil group（group S）, and combination of ropivacaine and sufentanil group（group RS）. The spinal catheter was placed at L3, 4 interspace.In group R, ropivacaine was given as an initial bolus of（0.6 mg/ml）5 ml followed by an infusion of 0.2 mg/ml after the analgesia pump was connected.In group S, sufentanil was given as an initial bolus of（1.6 μg/ml）5 ml followed by an infusion of 0.2 μg/ml after the analgesia pump was connected.In group RS, the mixture of ropivacaine 0.3 mg/ml plus sufentanil 0.8 μg/ml was given as an initial bolus of 5 ml, followed by an infusion of the mixture of ropivacaine 0.1 mg/ml plus sufentanil 0.1 μg/ml after the analgesia pump was connected.The analgesia pump was programmed to deliver a 5 ml bolus dose with a 15 min lockout interval, background infusion at a rate of 5 ml/h, and the total volume of 100 ml in the three groups.The analgesia pump was connected at 30 min after the initial bolus was given, and the infusion was stopped at 2 h after delivery in the three groups.Visual analog scale（VAS）scores were maintained ≤3.VAS scores were recorded before analgesia and at 5, 10 and 30 min after the initial bolus was given.The interval and duration of uterine contraction were recorded before analgesia, in 0-30 min, 30-60 min and 90-120 min of analgesia periods, and in the second stage of labor.The development of nausea and vomiting, pruritus, lateral episiotomy, assisted vaginal delivery, cesarean section, and post-dural puncture headache and requirement for oxytocin were recorded.Apgar scores at 1, 5 and 10 min after birth were recorded.ResultsThe Apgar score of the newborn was more than or equal to 7 at 1, 5 and 10 min after birth in the three groups.Compared with the value before analgesia, the interval of uterine contraction was significantly prolonged, and the duration of uterine contraction was significantly shortened in the 0-30 min of analgesia period in group R（P〈0.05）, and no significant change was found in the interval and duration of uterine contraction in each analgesia period in S and RS groups（P〉0.05）. Compared with group R, the VAS scores were significantly increased at 5 and 10 min after the initial bolus was given, the interval of uterine contraction was significantly shortened, and the duration of uterine contraction was significantly prolonged in S and RS groups, and the incidence of pruritus was significantly decreased in group S（P〈0.05 or 0.01）. Compared with group S, the incidence of pruritus was significantly decreased（P〈0.01）, and no significant change was found in the VAS scores at each time point and interval and duration of uterine contraction in each analgesia period in group RS（P〉0.05）.ConclusionContinuous subarachnoid block with combination of ropivacaine and sufentanil provides better efficacy for labor analgesia than either alone.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2016年第11期1309-1312,共4页
Chinese Journal of Anesthesiology
关键词
酰胺类
舒芬太尼
麻醉
脊椎
镇痛
产科
Amides
Sufentanil
Anesthesia, spinal
Analgesia, obstetrical
