盐酸罗哌卡因-舒芬太尼硬膜外和腰硬联合阻滞分娩镇痛的效果及安全性比较

目的比较盐酸罗哌卡因-舒芬太尼硬膜外和腰硬联合阻滞分娩镇痛的效果及安全性。方法选择ASAⅠ～Ⅱ级,足月,单胎,头位,并自愿要求行分娩镇痛的产妇60例,随机分为CEA组与CSEA组,选择同期无分娩镇痛产妇30例为对照组(C组)。CEA组以2%利多卡因为实验量,随后注入0.1%盐酸罗哌卡因+0.5μg/mL舒芬太尼10mL;CSEA组蛛网膜下腔给予舒芬太尼5μg。两组均采用0.08%盐酸罗哌卡因+0.4μg/mL舒芬太尼硬膜外PCA。记录疼痛评分,下肢肌力,产妇满意度,产程,新生儿Apart评分,产妇生命体征及不良反应。结果 3组下肢肌力、新生儿Apart评分、产妇生命体征比较,差异无统计学意义(P>0.05);与C组相比,CEA组与CSEA组VAS评分显著降低,第一产程缩短,差异有统计学意义(P<0.05);与CEA相比,CSEA组镇痛起效更快,产妇满意度更高(P<0.05)。结论盐酸罗哌卡因-舒芬太尼用于CEA和CSEA均能提供满意且安全的镇痛,CSEA因起效快,产妇满意度高更适合分娩镇痛。

Efficacy and safety of epidural or combined spinal-epidural labor analgesia with ropivacaine and sufentanil

Objective To compare the efficacy and safety of epidural or combined spinal-epidural labor analgesia with ropivacaine and sufentanil.Methods Sixty ASA Ⅰ-Ⅱ level,nulliparous parturients were randomly assigned to group CEA or group CSEA for labor analgesia with 30 cases each.30 nulliparous parturients over the same period without labor analgesia were taken as the control group(group C),experimentally to inject 2% lidocaine,then 0.1% ropivacaine plus 0.5 μg/mL sufentanil was needed in grape CEA.Sufentanil 5 μg was infused in grape CSEA,the epidural PCA with 0.08% ropivacaine plus 0.4 μg/mL sufentanil was administered in two groups.To record the level of pain,lower extremity muscle strength,satisfaction,time of stages,neonatal Apgar score,maternal symptom and the adverse reactions of painless childbirth group.Results The lower extremity muscle strength,neonatal Apgar score and maternal symptom had no significant difference on statistics in the two groups(P > 0.05).Compared with the C group,VAS score of the CEA and CSEA group was significantly diminish,the first stage of labor was shorter,the difference was statistically significant(P < 0.05).Compared with CEA,CSEA grape was faster in analgesia emerge with higher in maternal satisfaction(P < 0.05).Conclusion Ropivacainesufentanil for CEA and the CSEA is able to provide the satisfaction and safety of analgesia.CSEA is more suit for labor analgesia due to the rapid onset and high maternal satisfaction.