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目的探讨舒芬太尼于潜伏期应用于硬膜外分娩镇痛的临床效果及其对母婴的影响。方法先对初产妇进行痛域测定,排除对疼痛刺激特别敏感或不敏感者,然后选择自愿要求行分娩镇痛的单胎足月初产妇50例为镇痛组(A组),于宫口开大小于3cm时,于L2-3硬膜外穿刺,向头端置管4cm,回抽确认无血液或脑脊液后,给予0.075%的耐乐品和0.5ug/ml舒芬太尼混合液5ml,观察5分钟后,追加上述混合液5～10ml,调节麻醉平面至T10左右,接PCA泵,背景剂量为6～8ml/h,PCA量为5ml,锁定时间为20分钟,分娩结束后停药。另选50例同等条件未行分娩镇痛的初产妇作为对照组(C组)。行VAS评分和运动神经阻滞分级,观察记录产妇的生命体征、产程的进展、分娩方式、催产素的使用情况及不良反应。结果A组产妇的收缩压、舒张压及心率在镇痛后各时点与镇痛前比较差别没有统计学意义(P>0.05),与C组比较,各时点的血压及心率差别亦无显著性。与镇痛前比较,A组产妇镇痛前均感明显疼痛,镇痛后疼痛逐渐减轻,VAS评分降低,镇痛后30min疼痛明显缓解,而C组疼痛与前相比无减轻。A组下肢麻木,皮肤瘙痒发生率增加,催产素使用率增多(p<0.05),而两组的产程和分娩方式及新生儿Apgar评分差异无统计学意义(P>0.05)。结论0.075%罗哌卡因复合0.5ug/ml舒芬太尼用于潜伏期分娩镇痛,其镇痛效果确切,且不延长产程和改变分娩方式,对母婴影响小。
Objective To investigate the clinical effect of sufentanil in epidural analgesia during the incubation period and its effect on maternal and infant. Methods First determination of pain in primipara, exclusion of patients who are particularly sensitive or insensitive to pain stimulation, and then choose the voluntary single-fetus full-term labor analgesia 50 cases of early labor for the analgesic group (A group), in the cervix Size 3cm, L2-3 epidural puncture, the catheter to the head end of 4cm, back to confirm no blood or cerebrospinal fluid, given 0.075% of the refractory and 0.5ug / ml sufentanil mixture 5ml, 5 minutes after the observation, the above mixture was added 5 ~ 10ml, adjust the anesthesia plane to about T10, then PCA pump, the background dose of 6 ~ 8ml / h, PCA amount of 5ml, locking time was 20 minutes after stopping delivery. Another 50 cases of primipara without labor analgesia as the control group (C group). Line VAS score and motor nerve block grading, observe and record maternal vital signs, labor process, delivery mode, the use of oxytocin and adverse reactions. Results The systolic blood pressure, diastolic blood pressure and heart rate in group A were not significantly different from those before analgesia at all time points (P> 0.05). Compared with group C, there were no differences in blood pressure and heart rate at each time point Significance. Compared with the pre-analgesia, the pain in group A was significantly lower than that before before analgesia, the pain was relieved after analgesia, the VAS score was decreased, the pain was relieved 30 minutes after analgesia, and the pain in group C was not alleviated. A group of numbness lower limbs, the incidence of pruritus increased, the use of oxytocin increased (p <0.05), but the two groups of labor and delivery methods and neonatal Apgar score difference was not statistically significant (P> 0.05). Conclusion 0.075% ropivacaine combined with 0.5 ug / ml sufentanil is used for latent labor analgesia. Its analgesic effect is exact, and it does not prolong the labor process and change the mode of delivery.