舒芬太尼硬膜外分娩镇痛最佳浓度的临床研究

目的 探讨舒芬太尼用于硬膜外分娩镇痛的最佳浓度.方法 选择分娩镇痛初产妇150例,随机分为A、B、C、D、E五组.五组孕妇硬膜外穿刺成功后启用镇痛泵,负荷量12 mL,背景量4 mL,PCA 7 mL.各组镇痛泵配方如下：每组均用0.149％甲磺酸罗哌卡因60 mL,A组加入舒芬太尼6μg（0.1 μg/mL）,B组加入舒芬太尼12 μg（0.2 μg/mL）,C组加入舒芬太尼18 μg（0.3 μg/mL）,D组加入舒芬太尼24 μg（0.4 μg/mL）,E组加入舒芬太尼30 μg（0.5μg/mL）.记录镇痛起效时间、孕妇自控镇痛次数、舒芬太尼总量、不良反应、第二产程及剖宫产率等.观察新生儿脐带静脉血血气分析变化.结果 A组镇痛起效时间及孕妇自控镇痛次数均高于其余四组,差异有统计学意义（P＜0.05）；E组舒芬太尼总量高于其余四组,差异有统计学意义（P＜0.05）,瘙痒、恶心呕吐、尿潴留、胎心改变发生率及第二产程时间也均高于其他四组,差异有统计学意义（P＜0.05）,新生儿脐带静脉血血气分析与其余四组相比,差异有统计学意义（P＜0.05）.结论 0.149％甲磺酸罗哌卡因复合舒芬太尼硬膜外分娩镇痛时,舒芬太尼的最佳浓度是0.2～0.4 μg/mL.

Clinical study of the optimum concentration of Sulfentanil for epidural anesthesia in labor

Objective To research the optimum concentration of Sulfentanil for epidural anesthesia in labor. Methods 150 pregnant patients were randomly divided into 5 groups： group A, group B, group C, group D and group E. 5 groups of pregnant women after successful puncture were given patient controlled analgesia, load 12 mL, background 4 mL, PCA 7 mL. The analgesia pump formula as follows： each group was given 0.149% Ropivacaine Mesylate 60 mL, group A was given Sufentanil 6 μg （0.1 μg/mL）, group B was given Sufentanil 12 μg （0.2 μg/mL）, group C was given Sufen- tanil 18μg （0.3 μg/mL）, group D was given Sufentanil 24 μg （0.4 μg/mL）, group E was given Sufentanil 30 μg （0.5μg/mL）. The analgesic onset time, the number of maternal analgesia, the total dosage of Sufentanil, the untoward reaction, the second stage of labor and cesarean section rate were recorded. The changes of blood gas analysis of neonatal umbilical cord blood were observed. Results Analgesic onset time and pregnant women-controlled analgesia times of group A were higher than the other four groups, the difference was statistically significant （P 〈 0.05）. The amount of Sutentanil of group E was higher than the other four groups, the difference was statistically significant （P 〈 0.05）. The incidence of pruritus, nausea and vomiting, urinai7 retention, fetal heart rate changes and the second stage of la- bor time of group E were higher than the other four groups, the differences were statistically significant （P 〈 0.05）. There were significant differences in the newborn umbilical vein blood gas analysis among the group E and the four groups （P 〈 0.05）. Conclusion The optimum concentration of Sufentanil is 0.2-0.4 μg/mL for epidural labor analgesia when combined with 0.149% ethanesulfonic acid ropivacaine.