徐建武+林毅瑜

[摘要]目的 探讨舒芬太尼对瘢痕子宫经阴道分娩患者的镇痛效果及其对分娩结局的影响。方法 选取2015年7月～2016年9月在我院分娩的96例瘢痕子宮具备经阴道分娩适应症的患者，按照随机数表法分为观察组和对照组，各48例。观察组采用舒芬太尼进行镇痛，对照组患者不进行分娩镇痛。比较两组患者VAS评分及分娩结局。结果 镇痛前，两组患者VAS评分结果比较，差异均无统计学意义（P>0.05）；镇痛后10 min、20 min、30 min和宫口全开时，观察组患者VAS评分[（5.6±1.5）、（4.4±1.3）、（3.5±0.9）、（4.6±1.0）分]均低于对照组[（8.4±1.2）、（8.5±1.1）、（8.5±1.4）、（8.5±1.3）分]，差异有统计学意义（P<0.01）。两组患者中转剖功率、新生儿窒息发生率及新生儿体重比较，差异无统计学意义（P>0.05）。观察组产妇出血量[（335.2±150.8）ml]少于对照组[（446.4±146.5）ml]，住院时间[（4.1±2.0）d]短于对照组[（6.3±2.4）d]，差异有统计学意义（P<0.01）。结论 舒芬太尼用于瘢痕子宫阴道分娩镇痛效果显著，能有效减轻产妇痛苦，且中转剖宫率低，缩短住院时间，显著改善母婴结局。

[关键词]舒芬太尼；瘢痕子宫；阴道分娩；镇痛

[中图分类号] R614 [文献标识码] A [文章编号] 1674-4721（2017）05（c）-0053-03

[Abstract]Objective To explore the influence of Sufentanil on the analgesic effect and delivery outcome of vaginal delivery in patients with scarred uterus.Methods 60 patients with scarred uterus and received vaginal delivery in our hospital from July 2015 to September 2016 were selected and divided into the obseration group and the control group according to the random number table，with 48 cases in each group.The onservation group was treated with Sufentanil for analgesia，while the control group were not enrolled labor analgesia.The scores of VAS and the delivery outcome were compared between two groups.Results Before analgesia，there were no significantly different between the scores of VAS in two groups （P>0.05）； 10，20，30 min after analgesia and uterine orifice opend，the scores of VAS in the observation group [（5.6±1.5），（4.4±1.3），（3.5±0.9），（4.6±1.0） points] was lower than those in the control group [（8.4±1.2），（8.5±1.1），（8.5±1.4），（8.5±1.3） points]，and the differences were statistically significant （P<0.01）.There were no significant differences in the incidence of caesarean section and neonatal asphyxia， neonatal？weight between two groups （P>0.05）.The bleeding volume in the observation group [（335.2±150.8） ml] was less than that in the control group [（446.4±146.5） ml]，the hospital stays in the observation group [（4.1±2.0） d] was shorter than that in the control group [（6.3±2.4） d]， the differences were statistically significant （P<0.01）.Conclusion Sufentanil is effective in reducing the maternal pain， and the cesarean section rate is low， it can shorten the hospitalization time and improving the maternal and child outcomes significantly.

[Key words]Sufentanil；Scarred uterus；Vaginal delivery；Analgesia

剖宫产术、子宫肌瘤剔除术、子宫穿孔或破裂修复术、子宫成形术等妇产科手术之后均有可能形成瘢痕子宫，其中剖宫产术又是瘢痕子宫形成的主要原因。且医疗技术的发展使得剖宫产率逐年提升，从而使得瘢痕子宫产妇数量增多，瘢痕子宫产妇再次妊娠可能发生产后出血、子宫破裂等不良结局[1]。瘢痕子宫产妇再次行剖宫产并发损伤、粘连等的概率也会高于非瘢痕子宫产妇。瘢痕子宫对分娩和生产结局的影响都较大[2]。其中采用阴道分娩是一个可行的方式。此外，产妇对分娩镇痛也提出了较高的要求。有研究表明，舒芬太尼亲脂性更强，且与受体亲和力较强，具有镇痛效果好、持续时间长及作用迅速的优点，是目前临床上一种常用的镇痛药物[3-4]。研……