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目的产妇鞘内注射不同剂量舒芬太尼分娩镇痛的效应。方法 孕足月的初产妇100 例,ASA I或Ⅱ级,随机分为5组(n=20):舒芬太尼1μg组(A组)、舒芬太尼3μg组(B组)、舒芬太尼 5μg组(C组)、舒芬太尼7μg组(D组)和舒芬太尼10μg组(E组)。L2,3行脊椎-硬联合穿刺,鞘内注射 相应剂量舒芬太尼,硬膜外腔置管,接硬膜外自控镇痛(PCEA)泵。记录鞘内给药前、后产妇血压 (BP)、心率(HR)、呼吸频率(RR)、脉搏血氧饱和度(SpO2)。观察各组镇痛起效时间,应用视觉模拟镇 痛评分(VAS)评估疼痛效果,记录PCEA首次给药时间和总用药量,改良Bromage评分评价双下肢运动 阻滞情况。记录产妇出现不良反应和新生儿出生后1、5 min时Apgar评分。结果 各组年龄、身高、 体重、妊娠时间、宫口扩张程度比较差异无统计学意义(P>0．05)。与A组比较,B～E组镇痛起效时 间缩短,首次PCA给药时间延长,最高感觉阻滞平面上移;C～E组PCA药液总量、PCA按压次数减 少;B～E组鞘内给药后5—30min时有效镇痛率升高(P<0．05或0．01)。各组催产素使用率、分娩出 血量、镇痛满意度、新生儿出生后1、5 min时Apgar评分比较差异均无统计学意义(P>0．05)。D、E组 恶心呕吐、瘙痒、下肢麻木的发生率高于A、B组(P<0．01)。结论 产妇鞘内注射舒芬太尼联合 PECA分娩镇痛是安全、有效的,鞘内注射舒芬太尼的剂量以3～5μg为宜。
Objective To study the effect of different doses of sufentanil on labor analgesia induced by intrathecal intrathecal injection. Methods 100 cases of primiparae of full-term pregnancy were randomly divided into 5 groups (n = 20): 1μg sufentanil group (group A), 3μg sufentanil group (group B) Fentanyl 5μg group (C group), sufentanil 7μg group (D group) and sufentanil 10μg group (E group). L2, 3 spinal - hard joint puncture, the appropriate dose of intrathecal sufentanil, epidural catheter, epidural analgesia (PCEA) pump. Maternal blood pressure (BP), heart rate (HR), respiratory rate (RR) and pulse oxygen saturation (SpO2) were recorded before and after intrathecal administration. The onset time of analgesia in each group was observed. The visual analogue analgesia score (VAS) was used to evaluate the pain effect. The time of first administration and the total dosage of PCEA were recorded. The Bromage score was modified to evaluate the motion of both lower limbs. The maternal adverse reactions and Apgar scores at 1,5 min after birth were recorded. Results There was no significant difference in age, height, weight, gestational age and uterine expansion between groups (P> 0.05). Compared with group A, the onset time of analgesia in group B ~ E was shortened, the time of the first PCA administration was prolonged, and the maximum sensory block was moved up. The total amount of PCA liquid and PCA decreased in group C ~ E; Effective analgesia increased 5-30 min after intrathecal administration (P <0.05 or 0.01). There were no significant differences in the Apgar scores at 1, 5 min after birth between the two groups (P> 0.05). The incidences of nausea and vomiting, pruritus and lower limb numbness in groups D and E were higher than those in groups A and B (P <0.01). Conclusion The intrathecal injection of sufentanil combined with PECA for labor analgesia is safe and effective. The dose of sufentanil administered intrathecally is preferably 3 ~ 5μg.