Objective To compare the analgesic effects for breakthrough pain after epidural la-bor analgesia during vaginal delivery by different concentrations of ropivacaine with or without sufen-tanil.Methods A total of 60 full term nulliparous women with singleton (ASA physical status Ⅰ orⅡ)were included,who received successful epidural labor analgesia and experienced breakthrough pain during the first labor phrase.They were randomized into group A (n = 30)and group B (n =30),rescue dose with 0.1 5% pure ropivacaine and 0.08% ropivacaine plus sufentanil 0.4 μg/ml,re-spectively.The VAS score,modified Bromage score,boluses of rescue dose,consumption of analge-sics and oxytocin,durations of labor phrase,modes of labor,and side effects during labor were ob-served.Results Compared with group B,the VAS score 20 min after rescue dose for the break-through pain,the frequency of rescue,the dosage of sufentanil and the incidence of side effects such as itching and urine retention were significantly decreased in group A.Modified Bromage score was 0 in each group. The cases using oxytocin, labor time and childbirth way were similar. Conclusion Rescue dose of 0.1 5% ropivacaine can provide better analgesic effect than those of 0.08% ropivacaine plus sufentanil 0.4 μg/ml for the breakthrough pain during the first labor phrase, with less side effects and higher satisfaction scales.%目的：比较不同浓度罗哌卡因单独或复合舒芬太尼硬膜外给药抑制分娩镇痛中爆发痛的临床效果。方法选择成功施行硬膜外分娩镇痛后,第一产程中出现爆发痛的初产妇60例, ASA Ⅰ或Ⅱ级,足月单胎,随机分为0.15%罗哌卡因的追加组(A 组)和0.08%罗哌卡因复合舒芬太尼0.4μg/ml 的追加组(B 组),每组30例。记录产妇 VAS 评分、改良 Bromage 评分、追加次数、罗哌卡因、舒芬太尼用量及缩宫素使用例数、产程时间、分娩方式、不良反应等。结果与 B 组比较,A组爆发痛给予追加剂量20 min 后 VAS 评分明显降低,追加次数明显减少,舒芬太尼用量明显减少,皮肤瘙痒、尿潴留等不良反应发生率明显下降；两组改良 Bromage 评分均为0,缩宫素使用例数、产程时间、分娩方式差异无统计学意义。结论0.08%罗哌卡因复合舒芬太尼0.4μg/ml 背景输注8 ml/h 的情况下,0.15%罗哌卡因抑制分娩镇痛后第一产程中出现的爆发痛的效果明显优于0.08%罗哌卡因复合舒芬太尼0.4μg/ml,且不良反应少。
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