周晓琴 方进龙

[摘要] 目的 探讨罗哌卡因复合舒芬太尼用于潜伏期分娩镇痛的临床应用效果。 方法 将我院2014年1～12月收治的80例初产妇随机分为舒芬太尼组（罗哌卡因+舒芬太尼）和芬太尼组（罗哌卡因+芬太尼），每组各40例。潜伏期宫口开大2 cm时开始镇痛，采用腰硬联合阻滞后患者自控镇痛方式。观察宫口开大2、3、5、8、10 cm时VAS疼痛评分；记录产程、新生儿5 min Apgar评分、缩宫素使用率、产后出血量及产妇头晕头痛、恶心呕吐、皮肤瘙痒等不良反应的发生情况。 结果 两组产妇在年龄、体重、孕龄、第一产程、第二产程时间等方面比较，差异均无统计学意义（P>0.05）。宫口开大2 cm时，两组VAS评分比较差异无统计学意义（P>0.05）；舒芬太尼组VAS评分在宫口开大3、5、8、10 cm时均明显低于芬太尼组，差异有统计学意义（P<0.05）。两组新生儿Apgar评分、缩宫素使用率以及产后出血量比较，差异无统计学意义（P>0.05）。两组产妇分娩方式，头晕头痛、恶心呕吐、皮肤瘙痒等不良反应发生率比较差异无统计学意义（P>0.05）。 结论 罗哌卡因复合舒芬太尼腰硬联合阻滞用于潜伏期分娩镇痛可以取得显著的镇痛效果，且不会增加不良反应，值得临床推广。

[关键词] 罗哌卡因；舒芬太尼；芬太尼；分娩镇痛

[中图分类号] R614.4 [文献标识码] A [文章编号] 1674-4721（2016）02（b）-0101-03

Application effect of Ropivacaine combining with Sufentanil on labor analgesia during latent period

ZHOU Xiao-qin1 FANG Jin-long2

1.Department of Anesthesiology，Dongguan Shipai Hospital，Guangdong Province，Dongguan 523330，China；2.Maternity and Child Health Hospital in Dongguan City，Guangdong Province，Dongguan 523002，China

[Abstract] Objective To explore the clinical application effect of Ropivacaine combining with Sufentanil or Fentanyl for labor analgesia during latent period. Methods Eighty primiparae admitted into our hospital from January to December in 2014 were evenly divided into Sufentanil group （Ropivacaine plus Sufentanil） and Fentanyl group （Ropivacaine plus Fentanyl） in random.Anesthesia was used when uterine orifice was broadened to 2 cm during latent period.Patient-controlled analgesia was used after applying combined spinal-epidural anesthesia.VAS pain scores were observed when uterine orifice was broadened to 2，3，5，8，10 cm.The stage of labor，5 min Apgar score，oxytocin usage rate，amount of bleeding after delivery，and adverse reactions including dizziness，headache，nausea，vomiting，and skin itch，etc. were recorded. Results There was no statistical difference in age，weight，gestational age，or time of first or second stage of labor in the two groups （P>0.05）.On 2 cm size of uterine orifice，VAS score was not in significant different in both groups （P>0.05）.In the Sufentanil group，VAS scores were all lower than those in the Fentanyl group when the uterine orifice was broadened to 3，5，8，10 cm，which displayed statistical differences （P<0.05）.Neonatal Apgar score，oxytocin usage rate，and amount of bleeding after delivery were not in statistical differences in the two groups （P>0.05）.There was no significant difference in adverse reactions like puerperal delivery mode，dizziness，headache，nausea，vomiting，or skin itch，etc. in the two groups （P>0.05）. Conclusion Combined spinal-epidural anesthesia with Sufentanil and Ropivacaine used for labor analgesia during latent period can obtain a remarkable anesthetic effect，and not cause more adverse reactions，which is worthy of expansive promotion in clinic.

[Key words] Ropivacaine；Sufentanil；Fentanyl；Labor analgesia

分娩是妇女生产正常的生理过程，分娩时的疼痛程度比较严重，剧烈而持续的疼痛可以使得产妇产生一系列的神经-内分泌反应，对产妇正常分娩造成严重的影响[1]。对于产妇来说，理想的分娩镇痛药物不仅需要有良好的镇痛效果，影响宫缩产程作用较小，而且还要对母婴的影响极小，并发症少[2-3]。为了减少分娩过程中局麻药物的浓度和剂量，一般在分娩镇痛中使用阿片类药物复合局麻药进行镇痛[4]。与芬太尼比较……