鞘内注射不同剂量的罗哌卡因复合舒芬太尼的分娩镇痛效果(1)
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[摘要] 目的 比较不同剂量罗哌卡因复合舒芬太尼鞘内注射的分娩镇痛效应。 方法 选择有分娩镇痛要求的初产妇共27例，随机分为9组(每组3例)，而不同剂量的舒芬太尼(1.5 μg、2.0 μg、2.5 μg)和甲磺酸罗哌卡因(2.0 mg、2.5 mg、3.0 mg)复合成9个剂量。所有产妇均行腰硬联合阻滞，每组产妇分别于鞘内注射相应剂量的舒芬太尼以及罗哌卡因，硬膜外腔置管，接硬膜外自控镇痛(PCA)泵。以镇痛起效时间、镇痛持续时间为指标，用析因设计方差分析来评估各处理组之间的镇痛效果有无差异。 结果 舒芬太尼复合罗哌卡因的9种剂量的镇痛起效时间之间并无差异(F = 0.462，P = 0.762)，而每个剂量组的镇痛维持时间之间有差异，当舒芬太尼2.5 μg复合罗哌卡因2.5 mg时，镇痛维持时间最长(F = 3.297，P = 0.034)。 结论 蛛网膜下腔复合用药时，以2.5 μg舒芬太尼复合2.5 mg罗哌卡因的分娩镇痛效果最佳。
[关键词] 罗哌卡因；舒芬太尼；分娩镇痛
[中图分类号] R614 [文献标识码] B [文章编号] 1673—9701(2012)27—0087—02
The effects of labor analgesia for subarachnoid—epidural analgesia with different doses of ropivacaine combined with sufentanil
LU Liqin FENG Qiyun
Department of Gynaecology and Obstetrics，the No.3 People’s Hospital of Nanning，Nanning 530003，China
[Abstract] Objective To compare the effects of subarachnoid—epidural analgesia with different doses of ropivacaine combined with sufentanil during labor analgesia. Methods 27 primipara withrequisition for labor analgesia were randomly divided into 9 groups(3 cases/group)，and there were 9 doses combined with different doses of ropivacaine(2.0 mg，2.5 mg，3.0 mg) and sufentanil(1.5 μg，2.0 μg，2.5 μg). All patients were injected intrathecally corresponding doses of ropiva caine combined with sufentanil after combined spinal—epidural anesthesia，then an epiduralcatheter placed for patient—controlled epidural analgesis. The difference of analgesia effects between the groups were evaluated with the onset and duration of subarachnoid analgesia by？analysis of variance of factorial design. Results There was no significant difference for the onset in the 9 doses of ropivacaine combined with sufentanil(F = 0.462，P = 0.762)，but significantly difference for duration，especially the longest duration came from theropivacaine(2.5 mg) combined with sufentanil(2.5 μg)(F = 3.297，P = 0.034). Conclusion The best effects of labor analgesia was ropivacaine(2.5 mg) combined with sufentanil(2.5 μg) combined spinal—epidural anesthesia.
[Key words] Ropivacaine；Sufentanil；Labor analgesia
分娩痛是妇女在分娩过程中所经历的疼痛，它使产妇精神紧张，从而诱导机体产生应激反应，增加能量的消耗，致使后期宫缩乏力。同时，强烈的宫缩使胎盘血供减少，增加了胎儿宫内缺氧的概率。如何减轻分娩痛始终是研究的热点。目前常用的分娩镇痛方法中，因蛛网膜下腔—硬膜外联合阻滞(combined spinal—epidural anesthesia，CSEA)具有起效快、镇痛完善且安全的特点，近年来应用日益普及[1]。本次研究将对舒芬太尼复合罗哌卡因的配伍剂量作一探讨，现报道如下。
1 资料与方法
1.1 一般资料
选择2011年2～7月在我院产科、ASA I～Ⅱ级、单胎足月、有分娩镇痛要求的初产妇共27例，年龄21～32岁。所有产妇均无产前服用镇痛催眠药史，无凝血功能障碍，无宫缩乏力及妊娠合并症。舒芬太尼取3个剂量：1.5 μg，2.0 μg，2.5 μg；甲磺酸罗哌卡因也取3个剂量：2.0 mg，2.5 mg，3.0 mg，共9个剂量组。将产妇随机分入这9组，每组3例产妇。
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