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目的研究苏芬太尼蛛网膜下腔行分娩镇痛的效果。方法选择100例ASAⅠ～Ⅱ级、头位、单胎足月妊娠初产妇行自控硬膜外镇痛(PCEA)。苏芬太尼组(50例),蛛网膜下腔注射苏芬太尼5μg后60min,PCEA输注0.1%罗哌卡因的溶液,按PCA5ml/15min,于宫口开全时停泵。罗哌卡因组(50例),蛛网膜下腔注射罗哌卡因3mg后30min,PCEA输注0.1%罗哌卡因的溶液,按5ml/45min,于宫口开全时停泵。结果CSEA后VAS从镇痛前的(9.6±0.8)分迅速降为(0.5±0.8)分,且差异有统计学意义(P<0.01)。苏芬太尼分娩镇痛组的麻醉起效时间1～3min,到达最高镇痛平面时间为5min左右,镇痛维持时间60～90min。罗哌卡因分娩镇痛组的麻醉起效时间3～5min,到达最高镇痛平面时间为10min左右,镇痛维持时间30～50min。PCEA总量0～85ml,苏芬太尼分娩镇痛组罗哌卡因用量(6.5±2.5)mg/h,罗哌卡因分娩镇痛组罗哌卡因用量(11.9±4.7)mg/h。镇痛总有效率为100%。两组产妇MBS在镇痛前后无统计学差异(P>0.05),所有产妇均能下床活动。两组产程、Apgar评分和新生儿的SpO2,无统计学差异(P>0.05)。新生儿出生后脐静脉血中的苏芬太尼的含量未测出。母体动脉血及新生儿脐静脉血血气分析正常。结论苏芬太尼分娩镇痛,起效迅速、镇痛持续时间长、运动阻滞轻,副作用较小,对产妇和新生儿更安全,对母婴安全有益,是分娩镇痛较为理想的方法。
Objective To study the effect of sufentanil on labor analgesia in subarachnoid space. Methods 100 cases of ASA Ⅰ ~ Ⅱ grade, head position, single fetus full-term pregnancy primipara self-controlled epidural analgesia (PCEA). Sufentanil group (50 cases), subarachnoid injection of sufentanil 5μg 60min, PCEA infusion of 0.1% ropivacaine solution, according to PCA5ml / 15min, all in the cervix to open the pump. Ropivacaine group (50 cases), subarachnoid injection of ropivacaine 3mg 30min, PCEA infusion of 0.1% ropivacaine solution, according to 5ml / 45min, all in the cervix to open the pump. Results The VAS dropped rapidly from (9.6 ± 0.8) points to (0.5 ± 0.8) points before CSEA, and the difference was statistically significant (P <0.01). Sufentanil analgesia analgesia onset time of 1 ~ 3min, reached the highest analgesic plane time of about 5min, analgesic maintenance time 60 ~ 90min. Ropivacaine analgesia group anesthesia onset time 3 ~ 5min, to reach the highest analgesic plane time is about 10min, analgesic maintenance time 30 ~ 50min. The total amount of PCEA was 0-85ml, the dosage of ropivacaine in labor group was (6.5 ± 2.5) mg / h in sufentanil group, and the dosage of ropivacaine in labor analgesia group was 11.9 ± 4.7 mg / h . The total effective analgesia was 100%. There was no significant difference in MBS between the two groups before and after analgesia (P> 0.05). All mothers were able to get out of bed. No difference was found between the two groups of labor, Apgar score and neonatal SpO2 (P> 0.05). The content of sufentanil in umbilical venous blood after birth was not detected. Maternal arterial blood and neonatal umbilical blood gas analysis was normal. Conclusion Sufentanil analgesia during labor, rapid onset, long duration of analgesia, mild motor block, less side effects, more safe for mothers and newborns, safe for mothers and babies, and ideal for labor analgesia .