鞘内注射不同剂量舒芬太尼联合罗哌卡因分娩镇痛对宫缩的影响

摘要

目的：探讨不同剂量的舒芬太尼与罗哌卡因联合鞘内注射在分娩镇痛中对产妇宫缩的影响。方法选取2011年6月至2012年11月在深圳市福田区妇幼保健院妇产科待产的孕妇112例,将其按随机数字表法分为A组(n=42)、B组(n=42)、C组(n=42)三组,均给予舒芬太尼与罗哌卡因鞘内注射,舒芬太尼剂量分别为3μg、5μg、7μg,首剂罗哌卡因均为2 mg,对比三组产妇镇痛效果及产程和血清前列腺素 E2( PGE2)以及不良反应发生率。结果 A 组起效时间为(4．9±1．3) min,显著长于B、C组的(3．8±1．4) min与(3．5±1．3) min(P <0．05),首剂量持续时间为(64．4±13．6) min,显著短于B、C两组的(89．7±13．8) min与(91．2±14．1) min(P<0．05),罗哌卡因用量为(21．3±5．9) mg,显著多于B、C组的(18．3±6．1) mg与(16．2±5．8) mg(P<0．05),B、C两组在镇痛起效时间、首剂量持续时间以及罗哌卡因用量方面比较差异均无统计学意义(P >0．05)；三组产妇第一产程活跃时间、第二产程时间、第三产程时间以及血清PGE2、不良反应发生率比较差异均无统计学意义( P>0．05)。结论舒芬太尼与罗哌卡因联合鞘内注射用于分娩镇痛具有较为理想的镇痛效果,但不同剂量舒芬太尼并未对产妇宫缩起到不良影响。%Objective To discuss the influence of different doses of sufentanil combined with ropiva-caine for intrathecal injection on uterine contraction in labor analgesia. Methods A total of 112 puerperas in the Department of Gynecology and Obstetrics in Shenzhen Futian District Maternal and Child Health Care Hospital during Jun. 2011 and Nov. 2012 were divided into group A(n=42),group B(n=42),and group C(n=42) according to random number table method,all of them were given sufentanil combined with ropiv-acaine for intrathecal injection,the doses of sufentanil were 3μg,5μg,and 7μg,and ropivacaine 2 mg. Then the analgesic effects,duration of labor,serum PGE2 ,and incidence of adverse reactions of the three groups were contrasted. Results In group A,the onset time was (4. 9 ± 1. 3) min,significantly longer than (3. 8 ± 1.4) min and (3.5 ±1.3) min in group B and C(P<0.05),the first dose duration was (64.4 ±13.6) min,significantly shorter than (89.7 ±13.8) min and (91.2 ±14.1) min in group B and C(P<0.01), ropivacaine dosage was (21. 3 ± 5. 9) mg,significantly more than (18. 3 ± 6. 1) mg and (16. 2 ± 5. 8) mg in group B and C (P<0. 05),there were no significant differences in the onset time,the first dose duration, and ropivacaine dosage between group B and C(P>0. 05);there was no significant difference in the active time of the first stage of labor,the second stage of labor,the third stage of labor,serum PGE2 ,and the inci-dence of adverse reactions among the three groups(P>0. 05). Conclusion Sufentanil combined with ropiv-acaine for labor analgesia with intrathecal injection has an ideal analgesic effect, while different doses of sufentanil have no bad influence on uterine contractions.