【摘要】 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200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(100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PCA 5ml/15min,于宫口开全时停泵。罗哌卡因组(100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，是目前分娩镇痛较为理想的方法。

    【关键词】 苏芬太尼；罗哌卡因；镇痛；蛛网膜下腔；硬膜外

    A clinical study on spinal-epidural sufentanil labor analgesia

    FANG Man-jing,LI Jie.Department of Anesthesiology,Maternal and Child Health Care Hospital,Nanshan District,Shenzhen, Guangdong 518052,China

    【Abstract】 Objective To study the analgesic effects on combined spinal-epidural analgesia and sufentanil labor analgesia.Methods 200 ASA physical status Ⅰ or Ⅱparturients full-term at received PCEA.Sufentanil 5μg or 0.2% ropivacaine 3mg was injected into subarachnoid space.Sixty or thirty min after intrathecal injection PCEA was commenced.0.1% ropivacaine was used for PCEA.In PCEA the bolus does was 5ml with a 15min lockout interval and no background infusion.Results VAS was reduced from 9.6±0.8 before spinal analgesia to 0.5±0.8.The onset time of analgesia after intrathecal sufentanil was 1～3min,spinal analgesia was maintained for 60～90min.The 0.2% ropivacaine was (6.5±2.5)mg/h.The onset time of analgesia after intrathecal ropivacaine was 3～5min,spinal analgesia was maintained for 30～50min.The 0.2% ropivacaine was(11.9±4.7)mg/h.The 0.2% ropivacaine was 0～85ml.The success rate of labour analgesia was 100%.There are no difference in degree of motor block before and after labor analgesia(P>0.05).All parturients could freely walk out of bed in labor analgesia.There were no differences in neonatal Apgar scores between the two local anesthetics.Trace of sufentanil was not detected in umbilical blood samples.The blood gases analysis were normal in artery blood samples from mothers and umbilical blood samples.Conclusion CSEA with sufentanil for labor analgesia is highly effective,less motor block and no effect on the duration of labor and neonate score,it is safe for both mother and neonate,which may be one of the ideal techniques for the labor analgesia. ......