摘要： 目的 探讨不同剂量舒芬太尼蛛网膜下腔阻滞用于经产妇分娩镇痛的有效性和安全性。方法 收集2019年3月至10月于中国医科大学北部战区总医院产科就诊的90例行分娩镇痛经产妇的临床资料。本研究获得医院伦理委员会批准，患者均知情同意并签署知情同意书。采用随机数字表法分为3组：连续硬膜外分娩镇痛组（对照组，药液为0.1%罗哌卡因+0.33%舒芬太尼100 mL，首次剂量12 mL，背景剂量3 mL，自控剂量10 mL，锁时30 min）、舒芬太尼5 μg组[单次5 μg舒芬太尼蛛网膜下给药且留置硬膜外导管，连接硬膜外自控镇痛（PCEA）泵。药液为0.1%罗哌卡因+0.33%舒芬太尼100 mL，仅设自控给药，15 mL/次，锁时30 min]；舒芬太尼7.5 μg组（7.5 μg舒芬太尼蛛网膜下给药且留置硬膜外导管，连接PCEA泵。药液及设置同舒芬太尼5 μg组）。比较各组产妇实施分娩镇痛后VAS评分<3分所用的时间，给药至宫口开全时间，PCEA泵药总量，给药后30 min、60 min VAS评分，宫口开全时VAS评分；新生儿Apgar评分、脐动脉血pH值；产妇第二产程时间，宫口开全时改良Bromage评分，药物不良反应（恶心、皮肤瘙痒、呕吐、尿潴留、下肢麻木等）发生情况。结果 舒芬太尼7.5 μg组镇痛药物起效时间最短，且舒芬太尼5 μg组、舒芬太尼7.5 μg组达到VAS评分<3分所用时间明显少于对照组（P<0.01）。与对照组、舒芬太尼5 μg组比较，舒芬太尼7.5 μg组给药到宫口开全时间差异均有统计学意义（P<0.001），而对照组、舒芬太尼5 μg组比较差异无统计学意义（P=0.954）。PCEA泵注药量舒芬太尼7.5 μg组显著少于对照组、舒芬太尼5 μg组（P<0.01）。3组给药后30 min时VAS评分比较差异有统计学意义（P<0.001），舒芬太尼7.5 μg组VAS评分明显低于对照组（P<0.001），而舒芬太尼5 μg组、舒芬太尼7.5 μg组比较无统计学差异（P=0.632）。3组给药后60 min时VAS评分差异有统计学意义（P<0.001），其中对照组、舒芬太尼5 μg组VAS评分均高于舒芬太尼7.5 μg组（均P<0.001）。3组宫口全开时VAS评分差异有统计学意义（P<0.001），与对照组、舒芬太尼5 μg组比较，舒芬太尼7.5 μg组VAS评分明显降低（均P<0.001）。3组产妇第二产程时间、血气pH、宫口开全时改良Bromage评分，新生儿1、5、10 min Apgar评分比较差异均无统计学意义（均P>0.05）。与对照组、舒芬太尼5 μg组比较，舒芬太尼7.5 μg组下肢麻木、恶心、尿潴留发生率明显减少（均P<0.05），而对照组、舒芬太尼5 μg组间比较无统计学差异（均P>0.05）。结论 宫口≥ 3 cm以上的经产妇分娩时可优先选用7.5 μg舒芬太尼蛛网膜下给药的分娩镇痛方式。

经产妇不同剂量舒芬太尼蛛网膜下腔阻滞的分娩镇痛效果比较

那琦¹, 冯娅妮²

1. 中国医科大学北部战区总医院麻醉科, 沈阳 110002;
2. 中国医科大学附属第一医院麻醉科, 沈阳 110001

收稿日期:2021-01-29出版日期:2022-01-30发布日期:2021-12-30
通讯作者:冯娅妮E-mail:fengyani66@hotmail.com
作者简介:那琦(1988-),男,主治医师,硕士.



关键词: 舒芬太尼, 经产妇, 分娩镇痛
Abstract: Objective To explore the effectiveness and safety of the subarachnoid block with different doses of sufentanil for analgesia during labor. Methods We collected the clinical data of 90 women who had received labor analgesia in the Department of Obstetrics, General Hospital of Northern Theater Command, China Medical University, from March to October 2019. This study was approved by our hospital's ethics committee, and informed consent forms were signed by each patient. The patients were divided into three groups using the random number table method:the continuous epidural labor analgesia group (control group in which the preparation solution was 0.1% ropivacaine + 0.33% sufentanil 100 mL, the first dose was 12 mL, the background dose was 3 mL, the self-control dose was 10 mL, and the lock time was 30 min);the sufentanil 5 μg group[involving a single 5 μg sufentanil subarachnoid administration with an indwelling epidural catheter, connected to a patient controlled epidural analgesia (PCEA) pump, the drug solution was 0.1% ropivacaine + 0.33% sufentanil 100 mL, only set self-controlled drug delivery, 15 mL/time, lock time for 30 min];and the sufentanil 7.5 μg group (7.5 μg subarachnoid sufentanil administration via an indwelling epidural catheter, connected to a PCEA pump, the drug solution and settings were the same as those of the sufentanil 5 μg group). We compared the time taken for each group to attain parturient analgesia with VAS scores <3. The time from administration to the opening of the cervix;the total amount of PCEA pumps;the VAS scores at 30 and 60 min after the administration;the opening of the cervix;the full-time VAS score;the Apgar score of the newborns;the pH value of the umbilical arterial blood;time of the second stage of labor;modified Bromage score of the full-time cervical opening;and adverse drug reactions (nausea, skin pruritus, vomiting, urinary retention, numbness of lower limbs, etc.) were all noted. Results the sufentanil 7.5 μg group had the shortest onset time, and the time it took for the sufentanil 5 and 7.5 μg groups to attain VAS scores <3 was significantly less than that of the control group (P <0.01). From the administration to the full opening of the cervix, the difference between the sufentanil 7.5 μg group, and the control and sufentanil 5 μg groups, was statistically significant (P<0.001), while the difference between the control and sufentanil 5 μg groups was not statistically significant (P=0.954). The PCEA pump injection dose of the sufentanil 7.5 μg group was significantly lower than that of the control and sufentanil 5 μg groups (P<0.01). There was a statistically significant difference in the VAS scores of the three groups at 30 min after analgesia (P<0.001). The VAS score of the sufentanil 7.5 μg group was significantly lower than that of the control group (P<0.001). There was no significant difference between the sufentanil 5 and 7.5 μg groups (P=0.632). The VAS scores of the three groups at 60 min after analgesia were significantly different (P<0.001), and those of the control and sufentanil 5 μg groups were higher than those of the sufentanil 7.5 μg group (all P<0.001). There was a statistically significant difference in the VAS scores of the three groups when the cervix was fully opened (P<0.001). Compared with the control and sufentanil 5 μg groups, the VAS score of the sufentanil 7.5 μg group was significantly lower (all P<0.001). There were no significant differences in the time of the second labor, blood gas pH, and full-time uterine opening between the three groups. The Apgar scores of the newborns at 1, 5, and 10 minutes were not statistically different (all P>0.05). Compared with that in the control and 5 μg sufentanil groups, the incidence of lower limb numbness, nausea, and urinary retention was significantly reduced in the sufentanil 7.5 μg group (all P<0.05). There was no statistical difference between the control and sufentanil 5 μg groups (all P>0.05). Conclusion When a cervix ≥ 3 cm gives birth, the subarachnoid administration of sufentanil (7.5 μg) is the preferred method of inducing labor analgesia.
Key words: sufentanil, multipara, analgesia during labor
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