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目的比较不同剂量罗哌卡因联合舒芬太尼蛛网膜下腔注射分娩镇痛的效果。方法单胎头位足月初产妇240例,随机分为3组(n=80):罗哌卡因1.50 mg组、罗哌卡因1.75 mg组、罗哌卡因2.00 mg组。于L2～3行腰硬联合阻滞,蛛网膜下腔注射相应剂量舒芬太尼,硬膜外腔置管,接硬膜外自控镇痛(PCA)泵。记录起效时间、首次用药持续时间、蛛网膜下腔给药后VAS评分、局麻药总量、运动阻滞、各产程时间、分娩方式及产前宫缩素使用。整个产程持续监测胎心、宫缩、血压、血氧饱和度、新生儿1 min、5 min、10min Apgar评分与不良反应。结果 3组均获得良好的镇痛效果。罗哌卡因1.75 mg组、罗哌卡因2.00 mg组维持时间长,与1.50 mg组比较差异有统计学意义(P<0.05);2.00 mg罗哌卡因组阴道器械助产率、产前宫缩素使用率比1.50 mg组、1.75 mg组高(P<0.05)。各产程时间、新生儿Apgar评分、各组间差异无统计学意义(P>0.05)。结论罗哌卡因1.50 mg、1.75 mg、2.00 mg联合舒芬太尼5μg蛛网膜下腔注射分娩镇痛均安全、有效,尤以罗哌卡因1.75 mg、舒芬太尼5μg联合更佳。
Objective To compare the analgesic effects of different doses of ropivacaine and sufentanil during subarachnoid injection labor. Methods One hundred fetus with full-term primiparae was randomly divided into 3 groups (n = 80): ropivacaine 1.50 mg group, ropivacaine 1.75 mg group and ropivacaine 2.00 mg group. In the L2 ~ 3 line of lumbar and epidural block, subarachnoid injection of sufentanil dose, epidural catheter, epidural analgesia (PCA) pump. Record the onset time, duration of first administration, VAS score after subarachnoid administration, total amount of local anesthetic, locomotor block, duration of labor, mode of delivery, and preterm labor. Fetal heart, uterine contraction, blood pressure, oxygen saturation, neonatal 1 min, 5 min, 10 min Apgar score and adverse reactions were monitored continuously throughout the labor process. Results All three groups received good analgesic effect. Ropivacaine 1.75 mg group and ropivacaine 2.00 mg group maintained a long time, compared with 1.50 mg group, the difference was statistically significant (P <0.05); 2.00 mg ropivacaine vaginal device midwifery rate, prenatal Uterine prime use rate than 1.50 mg group, 1.75 mg group (P <0.05). The duration of labor, neonatal Apgar score, the difference between the groups was not statistically significant (P> 0.05). Conclusion The analgesia of ropivacaine 1.5 mg, 1.75 mg, 2.00 mg combined with sufentanil 5 μg subarachnoid injection was safe and effective, especially ropivacaine 1.75 mg and sufentanil 5 μg.