幸贵萍,王亚平
XING Guiping,WANG Yaping

• 1:中南大学湘雅二医院麻醉科

摘要(Abstract)：

目的:探讨不同浓度舒芬太尼复合罗哌卡因硬膜外麻醉对无痛分娩产妇镇痛效果、新生儿Apgar评分及血气分析的影响。方法:90例行无痛分娩产妇均分为3组,A组采用生理盐水复合0. 10%罗哌卡因硬膜外麻醉、B组采用0. 25 mg/L舒芬太尼0. 1 m L复合0. 10%罗哌卡因5 m L硬膜外麻醉,C组采用0. 50 mg/L舒芬太尼0. 1 m L复合0. 10%罗哌卡因5 m L硬膜外麻醉;比较不同浓度舒芬太尼用于硬膜外麻醉对产妇分娩镇痛效果(NRS评分)、产程时间、分娩方式及新生儿Apgar评分、血气分析的影响。结果:B、C组受试产妇镇痛5、10、30、60 min、宫口开7～8 cm及宫口全开6个时刻的NRS评分均低于A组,C组低于B组(P <0. 05); C组受试产妇第一产程时间短于A、B组,B组短于A组(P <0. 05); B、C组受试产妇第二产程时间短于A组(P <0. 05); C组自然分娩产妇比例高于A、B组,B组高于A组(P <0. 05),而阴道助产及剖宫产产妇人数低于A、B组,B组低于A组(P <0. 05);新生儿出生后1、5、10 min时的Apgar评分及p H值、Pa O2、Pa CO2等脐动脉血气相关指标比较,差异无统计学意义(P> 0. 05)。结论:0. 50 mg/L舒芬太尼0. 1 m L复合0. 10%的罗哌卡因5 m L的硬膜外麻醉方案在无痛分娩过程中提供较好镇痛效果的同时,还缩短了第一产程时间,且不影响新生儿评分Apgar评分和血气分析。
Objective: To investigate the effects of different concentrations of epidural analgesia combination of ropivacaine with sufentanil on painless childbirth,neonatal Apgar score and blood gas analysis. Methods: 90 cases of painless childbirth were divided into 3 groups by random number method.Group A received epidural anesthesia with normal saline combined with 0. 10% ropivacaine; group B received 0. 1 m L of 0. 25 mg/L sufentanil combined with 5 m L of 0. 10% ropivacaine for epidural anesthesia; group C received 0. 1 m L of 0. 50 mg/L sufentanil combined with 5 m L of 0. 10% ropivacaine for epidural anesthesia. The effects of different concentrations of epidural analgesia with sufentanil during labor,duration of labor,mode of delivery,Apgar score and blood gas analysis were compared. Results: The NRS scores of group B and C were obtained at six time points: 5 min,10 min,30 min,and 60 min after labor epidural analgesia,and when cervix dilates to approximately 7 ～ 8 cm,and 10 cm. The obtained scores were lower than those of group A,while scores of group C were lower than B group( P < 0. 05). In group C,the first stage of labor was shorter than that of group A and B,while that in group B was shorter than group A( P < 0. 05). In group B and C,the second stage of labor was shorter than group A( P < 0. 05). The proportion of natural childbirth in group C was higher than that in group A and B,while that in group B was higher than that in group A( P < 0. 05). In group C,the number of women with assisted vaginal delivery( AVD) and cesarean section were lower than that of group A and B,while that in group B was lower than group A( P < 0. 05). Apgar scores of 1min,5min and 10 min after birth and p H value,PaO2,PaCO2 and other umbilical cord blood gas indexes were not statistically significant( P > 0. 05). Conclusion: 0. 1 m L of 0. 50 mg/L sufentanil combined with 5 m L of 0. 10% ropivacaine for epidural anesthesia provides better analgesic effect for painless childbirth,shortens the first stage of labor,and does not affect Apgar score and blood gas analysis.

关键词(KeyWords)： 舒芬太尼;罗哌卡因;无痛分娩;分娩结局;新生儿
sufentanil;ropivacaine;painless delivery;delivery outcome;neonate

Abstract:

Keywords:

基金项目(Foundation): 湖南省自然科学基金资助项目(2017JJ2342)

作者(Author): 幸贵萍,王亚平
XING Guiping,WANG Yaping

DOI: 10.19367/j.cnki.1000-2707.2018.12.030

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