摘要
目的通过与脊椎-硬膜外联合镇痛和硬膜外镇痛比较，评价蛛网膜下腔输注舒芬太尼用于分娩镇痛的临床效果。方法选择足月孕妇120例，ASA分级Ⅰ或Ⅱ级，自愿要求自然分娩镇痛。采用随机数字表法，将产妇随机分为3组（n=40），蛛网膜下腔镇痛组（S组）、脊椎-硬膜外联合镇痛组（C组）和硬膜外镇痛组（E组）。产妇宫口开大2～3cm时，S组行3,4间隙蛛网膜下腔镇痛，先经导管注射舒芬太尼8／zg（5m1），然后连接电子镇痛泵，配方：舒芬太尼100μg溶于100ml生理盐水中，背景输注速率2ml／h，PCA2ml／次，锁定时间10rain，限量14ml／h。C组行L，间隙脊椎-硬膜外联合镇痛，蛛网膜下腔注射舒芬太尼8tLg（5m1），硬膜外导管连接电子镇痛泵，配方：0．1％罗哌卡因200mg＋0．5pg／ml舒芬太尼100μg混合液200ml，背景输注速率6ml／h，PCA6ml／次，锁定时间10min，限量40ml／h。E组行L2，3间隙硬膜外镇痛，硬膜外导管连接电子镇痛泵，配方同C组。于镇痛前、镇痛开始后5、10、15、30、60、120min、宫口开大7～8cm、宫口开全（T0-8）时记录收缩压、舒张压、心率、基线胎心率和宫缩强度。记录不良反应的发生情况。于镇痛10min时行改良Bromage分级。行新生儿1、5、10minApgar评分。产后24h行产妇镇痛满意度评价。结果S组血流动力学各指标、基线胎心率和宫缩强度均在正常范围，产妇镇痛满意度为优良、Bromage分级0级，2例产妇在产后发生了硬脊膜穿刺后头痛，自行缓解，瘙痒发生率42％，均为轻度瘙痒，新生儿1、5、10minApgar评分分别为9．1±0．4、9．6±0．4、10分，未见心血管事件发生，上述指标S组与C组和E组比较差异无统计学意义（P〉0．05）。结论蛛网膜下腔输注舒芬太尼镇痛效果确切，适用于分娩镇痛，与脊椎．硬膜外联合镇痛和硬膜外镇痛效果无差异。
Objective To evaluate the clinical effects of continuous spinal anesthesia （CSA） with sufentanil for labor analgesia when compared with the effects of combined spinal-epidural analgesia （CSEA） and continuous epidural analgesia （CEA） .Methods One hundred ASA I or II nulliparous patients who were at full term and who requested labor epidural analgesia, were randomly divided into 3 groups （ n = 40 each） ： continuous spinal analgesia group （group S）, combined spinal-epidural analgesia group （group C）. and continuous epidural analgesia group （group E）. Labor analgesia was performed when the cervical dilation was 2-3 cm. In group S, the spinal catheter was placed at L3.4 interspace, and patient-controlled analgesia （PCA） with sufcntanil was performed after a loading dose of sufentanil 8 /zg. PCA solution contained sufentanil 100μg in 100 ml of normal saline. The PCA pump was set up with a 2 ml bolus dose, a 10 min lockout interval （Volume was limited to 14 ml/h） and back-ground infusion at a rate of 2 ml/h. In group C, CSEA was performed at 1,2.3 interspace, the patients received intrathecal sufentanil 8 μg via a spinal needle, the PCA solution contained 0.1% ropivacaine 200 mg and 0.5 μg/ml sufentanil 100 μg in 200 ml of normal saline. The CSEA pump was set up with a 6 ml bolus dose, a l0 rain lockout interval （volume was limited to 40 ml/h） and background infusion at a rate of 6 ml/h. In group E, CEA was performed at L2.3 interspace and the method was the same as in group C. The systolic pressure, diastolic pressure, HR, fetal heart rate （FHR） and intensity of uterine contraction were recorded before analgesia and 5, 10, 15, 30, 60 and 120 min after beginning of analgesia, when the cervical dilation was 7-8 cm, and when the uterine cervix dilated absolutely. The side effects were recorded. Bromage scale was assessed at 10 rain of analgesia. Apgar scores of the neonates were recorded at 1, 5 and 10 min after birth. The analgesic effect was evaluated 24 h after birth.Re
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2013年第1期65-68,共4页
Chinese Journal of Anesthesiology
基金
北京市卫生局青年科学研究资助项目（QN2009-019）
关键词
蛛网膜下腔
舒芬太尼
分娩
镇痛
Subarachnoid space
Sufentanil
Parturition
Analgesia
