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目的:比较鞘内不同剂量的舒芬太尼在腰硬联合阻滞分娩镇痛中的效应。方法:选择择期初产妇180例,鞘内镇痛药物为舒芬太尼,随机分六组,剂量分别为3.0μg、4.0μg、5.0μg、6.0μg、7.0μg、8.0μg(S3组、S4组、S5组、S6组、S7组、S8组),双盲对照观察。各组镇痛方法均采用蛛网膜下腔给药后硬膜外产妇自控镇痛(PCA)。各组硬膜外维持用药相同。观察记录起效时间;鞘内给药后10、15、30、60、90 m in时的VAS评分;维持时间、运动阻滞、各产程时间、出血量、新生儿1和5分钟Apagr评分与全程分娩镇痛的满意度;可能出现的不良反应。结果:起效时间S3组>S4组>S5组≈S6组≈S7组≈S8组,以S3组最慢。S3组在各时间点镇痛效果均比S5~S8组差,60m in时S4、S5组的镇痛效果与S6、S7相似,但明显弱于S8组(P<0.05);S3组、S4组的维持时间明显短于S5~S8组(P<0.05)。S3组、S4组满意度明显差于S5~S8组(P<0.05)。各组产程时间、出血量、新生儿Apgar评分、改良Bromage评分、瘙痒发生率各组间无明显差异(P>0.05)。结论:单纯鞘内注射4.0~8.0μg舒芬太尼均可提供安全、有效的分娩镇痛效果,但镇痛剂量以5.0~6.0μg更佳。
OBJECTIVE: To compare the effects of different doses of sufentanil in intrathecal epidural analgesia on labor analgesia. Methods: 180 cases of primipara at the beginning of elective period and sufentanil intrathecal analgesia were randomly divided into six groups at doses of 3.0μg, 4.0μg, 5.0μg, 6.0μg, 7.0μg and 8.0μg respectively Group, S5 group, S6 group, S7 group, S8 group), double-blind control. Epidural analgesia (PCA) was used after subarachnoid administration in each group. Each group of epidural maintenance medication the same. VAS score at 10, 15, 30, 60, and 90 min after intrathecal administration; duration of maintenance, motor block, duration of labor, amount of bleeding, 1 and 5 minutes neonatal Apagr score and Satisfaction with analgesia throughout labor; possible adverse reactions. Results: The onset time of S3 group> S4 group> S5 group ≈S6 group ≈S7 group ≈S8 group, the slowest in S3 group. The analgesic effect of S3 group was worse than that of S5 ~ S8 group at each time point. The analgesic effect of S4 and S5 group was similar to that of S6 and S7 at 60m in, but weaker than that of S8 group (P <0.05) Group maintained significantly shorter than the S5 ~ S8 group (P <0.05). The satisfaction of S3 group and S4 group was significantly lower than that of S5 ~ S8 group (P <0.05). There was no significant difference between the two groups in the duration of labor, blood loss, neonatal Apgar score, modified Bromage score and pruritus incidence in each group (P> 0.05). CONCLUSIONS: Intrathecal injection of 4.0 ~ 8.0 μg sufentanil alone may provide a safe and effective analgesia for labor but a dose of 5.0 ~ 6.0 μg is preferred.