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| 罗哌卡因复合舒芬太尼连续蛛网膜下腔阻滞用于全产程分娩镇痛的临床效果 |
| Analgesic effect of ropivacaine combined with sufentanil for continuous spinal anesthesia during labor |
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| DOI：10.12089/jca.2020.02.002 |
| 中文关键词: 连续蛛网膜下腔阻滞 腰-硬联合阻滞 分娩镇痛 罗哌卡因 舒芬太尼 |
| 英文关键词: Continuous spinal anesthesia Combined spinal-epidural anesthesia Labor analgesia Ropivacaine Sufentanil |
| 基金项目:北京市卫生和计划生育委员会科技成果和适宜技术推广项目(2018-TG-21) |
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| 中文摘要: |
目的 观察罗哌卡因复合舒芬太尼连续蛛网膜下腔阻滞用于全产程分娩镇痛的效果。
方法 选择2018年3—10月在北京妇产医院全产程分娩镇痛的足月妊娠单胎头位初产妇97例,年龄23～35岁,体重60～90 kg,ASAⅠ或Ⅱ级,采用随机数字表法分为两组:连续蛛网膜下腔阻滞组(CSA组,n=48)和腰-硬联合阻滞组(CSEA组,n=49)。产妇子宫规律收缩后行分娩镇痛,CSA组经蛛网膜下腔推注罗哌卡因03 mg／ml+舒芬太尼1 μg／ml共5 ml,20 min后连接镇痛泵;CSEA组经蛛网膜下腔推注罗哌卡因03 mg／ml+舒芬太尼1 μg／ml共5 ml,20 min后连接硬膜外镇痛泵。所有产妇持续应用镇痛泵至第三产程结束。记录镇痛即刻(T1)、镇痛后10 min(T2)、30 min(T3)、60 min(T4)、宫口开全(T5)、胎头娩出(T6)、胎盘娩出(T7)时的MAP和VAS疼痛评分;记录镇痛前、镇痛后0～30 min、30～60 min、90～120 min和第二产程的宫缩持续时间和宫缩间隔时间;记录缩宫素使用情况和分娩方式;记录恶心呕吐、瘙痒、产后出血和硬脊膜穿刺后头痛(PDPH)的发生情况;记录新生儿体重、出生后1、5、10 min Apgar评分和脐带动脉血血气分析。
结果 与CSEA组比较,T2、T5、T6时CSA组MAP和VAS疼痛评分明显降低(P＜0.05);镇痛后0～30 min CSA组宫缩持续时间明显缩短(P＜0.05),宫缩间隔时间明显延长(P＜0.05)。CSA组缩宫素使用率、瘙痒发生率明显高于CSEA组(P＜0.05)。两组分娩方式以及恶心呕吐、产后出血、PDPH发生率差异无统计学意义。两组新生儿体重、出生后1、5、10 min Apgar评分和脐带动脉血血气分析差异无统计学意义。
结论 与腰-硬联合阻滞比较,连续蛛网膜下腔阻滞具有用药量小的特点,对产妇、胎儿影响较小,可安全用于全产程分娩镇痛。 |
| 英文摘要: |
Ojective To study the feasibility and effect of continuous spinal anesthesia with ropivacaine combined with sufentanil for labor analgesia.
Methods Ninety-seven primipara and full-term pregnancies, aged 23-35 years, weighing 60-90 kg, falling into ASA physical status Ⅰ or Ⅱ, were selected in Beijing Obstetrics and Gynecology Hospital from March to October 2018. The parturients were divided into two groups by random number table method: continuous spinal anesthesia group (group CSA, n = 48) and combined spinal-epidural anesthesia group (group CSEA, n = 49). After the regular contraction of uterus, the parturient received labor analgesia. The parturients in group CSA received a loading dose of 5 ml solution of 0.3 mg／ml ropivacain and sufentanil 0.2 μg／ml, the parturients in group CSEA received a loading dose of 5 ml solution of 0.3 mg／ml ropivacain and sufentanil 0.2 μg／ml. After 20 min, the parturients received the corresponding analgesic pump, and the analgesic pump lasted until the end of the third stage of labor. The MAP, VAS scores were recorded before labor analgesia (T1), 10 min after analgesia (T2), 30 min after analgesia (T3), 60 min after analgesia (T4), at the end of the first stage of labor (T5), at the end of the second stage of labor (T6), and at the end of the third stage of labor (T7). The uterine contraction persistence time and uterine contraction interval time were monitored before analgesia, 0-30 min after analgesia, 30-60 min after analgesia, 90-120 min after analgesia and in the second stage of labor. The use of oxytocin, postpartum hemorrhage and delivery mode were recorded. The incidence of nausea, vomiting, pruritus and post-dural puncture headache (PDPH) were recorded. The neonatal weight, Apgar scores 1, 5 and 10 min after birth, and umbilical artery blood gas analysis were recorded.
Results Compared with group CSEA, the MAP and VAS scores decreased significantly at T2, T5 and T6(P ＜ 0.05), the interval of uterine contraction was significantly prolonged 0-30 min after analgesia, the duration of uterine contraction was significantly shortened in group CSA (P ＜ 0.05). The usage rate of oxytocin use and the incidence of pruritus in group CSA were significantly higher than those in group CSEA (P ＜ 0.05). There were no significant differences in the incidence of birth and nausea and vomiting, postpartum hemorrhage, and PDPH between the two groups. There were no significant differences in the weight of the newborns, Apgar scores 1, 5, and 10 min after birth, and artery blood gas analysis of the newborns.
Conclusion Compared with combined spinal-epidural anesthesia, continuous spinal anesthesia has the characteristics of small dosage and less influence on the fetus. It can be safely used for labor analgesia as combined spinal-epidural anesthesia. |
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