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目的探讨鞘内注射不同剂量舒芬太尼联合罗哌卡因在产妇分娩镇痛中的应用效果。方法选取灵川县妇幼保健院2014年6—12月收治的待产孕妇120例,根据麻醉用药剂量的不同随机分为A、B、C组,各40例。A、B、C组产妇分别于鞘内注射舒芬太尼3.0 ug、5.0 ug、7.0 ug,同时均注射罗哌卡因。比较3组产妇镇痛效果,包括镇痛起效时间、初次用药剂量持续时间及视觉模拟评分法(VAS)评分、改良Bromage评分、产程时间(第一产程活跃时间、第二产程、第三产程)及新生儿娩出后1 min、5 min Apgar评分,并比较3组产妇剖宫产、器械助产及不良反应发生情况。结果 3组产妇VAS评分、改良Bromage评分比较,差异无统计学意义(P>0.05)。B、C组产妇镇痛起效时间短于A组,初次用药剂量持续时间长于A组(P<0.05);B、C组产妇镇痛起效时间、初次用药剂量持续时间比较,差异无统计学意义(P>0.05)。3组产妇第一产程活跃时间、第二产程及第三产程比较,差异无统计学意义(P>0.05)。分娩后1 min、5 min,3组产妇新生儿Apgar评分比较,差异无统计学意义(P>0.05)。3组产妇剖宫产率、器械助产率比较,差异无统计学意义(P>0.05)。B、C组产妇不良反应率低于A组(P<0.05);B、C组产妇不良反应率比较,差异无统计学意义(P>0.05)。结论鞘内注射不同剂量舒芬太尼联合罗哌卡因在产妇分娩镇痛中的应用效果一致,但5.0μg、7.0μg舒芬太尼起效时间快,持续时间长,且安全性好。
Objective To investigate the effect of intrathecal sufentanil combined with ropivacaine in maternal labor analgesia. Methods 120 cases of pregnant women who were admitted to Lingchuan County Maternal and Child Health Hospital from June to December 2014 were randomly divided into A, B and C groups, 40 cases in each group according to the dose of anesthesia. A, B, C group of women were intrathecal sufentanil 3.0 ug, 5.0 ug, 7.0 ug, while ropivacaine were injected. The analgesic effect, including duration of onset of analgesia, duration of initial dose, visual analog scale (VAS) score, modified Bromage score, duration of labor (active labor in the first stage of labor, second stage of labor, third stage of labor ) And Apgar score at 1 min and 5 min after delivery, and cesarean section, equipment midwifery and adverse reactions were compared among the three groups. Results There were no significant differences in VAS score and Bromage score between the three groups (P> 0.05). The onset time of analgesia in group B and C was shorter than that in group A, and the duration of initial dose was longer than that in group A (P <0.05). The onset time of analgesia and the duration of initial dose in groups B and C were no statistical difference Significance (P> 0.05). There was no significant difference in the active time of the first stage of labor, the second stage of labor and the third stage of labor between the three groups (P> 0.05). Apgar scores of neonates in 3 maternal newborns at 1 min and 5 min after delivery showed no significant difference (P> 0.05). Cesarean section rate of 3 groups of maternal and device midwifery rate comparison, the difference was not statistically significant (P> 0.05). The adverse reaction rate of maternal women in groups B and C was lower than that in group A (P <0.05). There was no significant difference in adverse reactions among males in groups B and C (P> 0.05). Conclusion The effects of intrathecal sufentanil combined with ropivacaine on labor analgesia were consistent. However, 5.0μg and 7.0μg sufentanil had faster onset, longer duration and better safety.