| 摘要: |
| ［摘要］ 目的 评估不同剂量舒芬太尼复合罗哌卡因在分娩镇痛中的应用效果及对母婴转归的影响。方法 选择2017年1月至2020年8月于唐山市妇幼保健院接受无痛分娩的产妇210例。采用随机数字表法将其分为A组、B组和C组，每组70例。因有14例中转剖宫产，最终纳入产妇196例，其中A组65例，B组66例，C组65例。三组镇痛方案不同：A组，舒芬太尼0.3 μg/ml复合0.1%罗哌卡因；B组，舒芬太尼0.4 μg/ml复合0.1%罗哌卡因；C组，舒芬太尼0.5 μg/ml复合0.1%罗哌卡因。比较三组分娩镇痛前（T0）、分娩镇痛开始后30 min（T1）、宫口开全时（T2）以及产后2 h（T3）的视觉模拟量表（VAS）评分。比较三组分娩后1 h的改良Bromage评分。比较三组产程及产妇和新生儿的转归情况。结果 C组产妇第一产程较A组和B组显著延长（P<0.05）。三组第二和第三产程比较差异均无统计学意义（P>0.05）。三组产钳使用率、侧切率，以及产道裂伤和产后出血发生率比较差异均无统计学意义（P>0.05）。在T0～T3时间点，三组VAS评分均呈下降趋势，B组和C组的VAS评分下降趋势较A组更显著（P<0.05），且在T1～T3时间点，C组的VAS评分较B组、C组更低，差异有统计学意义（P<0.05）。三组改良Bromage评分比较差异无统计学意义（P>0.05）。三组新生儿出生体重，第1分钟、第5分钟和第10分钟Apgar评分，脐动脉血pH值，脐动脉血PCO2以及脐动脉血PO2比较差异均无统计学意义（P>0.05）。结论 0.3、0.4、0.5 μg/ml舒芬太尼复合0.1%罗哌卡因均可安全有效应用于分娩镇痛，其中0.4 μg/ml舒芬太尼联合0.1%罗哌卡因镇痛对产程影响小，推荐临床使用。 |
| 关键词: 舒芬太尼 罗哌卡因 分娩镇痛 转归 |
| DOI：10.3969/j.issn.1674-3806.2022.12.10 |
| 分类号:R 614 |
| 基金项目:河北省医学科学研究重点课题计划（编号：20181354） |
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| Application effects of different doses of sufentanil combined with ropivacaine on labor analgesia and evaluation of their influences on maternal and infant outcomes |
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LIU Guo-dong, JIA Yu-gang, QIANG Rui-hua, et al.
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Department of Anesthesiology, Tangshan Maternal and Child Health Hospital, Hebei 063000, China
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| Abstract: |
| ［Abstract］ Objective To evaluate the application effects of different doses of sufentanil combined with ropivacaine on labor analgesia and their influences on maternal and infant outcomes. Methods Two hundred and ten parturients who underwent painless delivery in Tangshan Maternal and Child Health Hospital from January 2017 to August 2020 were selected. They were divided into group A, group B and group C by random number table method, with 70 cases in each group. Because 14 cases were converted to cesarean section, 196 cases were finally included, including 65 cases in the group A, 66 cases in the group B and 65 cases in the group C. The analgesic regimens of the three groups were different: the group A, sufentanil 0.3 μg/ml combined with 0.1% ropivacaine; the group B, sufentanil 0.4 μg/ml combined with 0.1% ropivacaine; the group C, sufentanil 0.5 μg/ml combined with 0.1% ropivacaine. The Visual Analogue Scale(VAS) scores were compared among the three groups before labor analgesia(T0), 30 min after labor analgesia(T1), at the time when the uterus opened to the full extent(T2) and 2 hours after delivery(T3). The modified Bromage scores were compared among the three groups 1 hour after delivery. The course of labor and the maternal and neonatal outcomes were compared among the three groups. Results The first stage of labor in the group C was significantly longer than that in the group A and the group B(P<0.05). There were no significant differences in the second and third stages of labor among the three groups(P>0.05). There were no significant differences in the utilization rate of forceps, the rate of lateral episiotomy, the incidence of birth canal laceration and the incidence of postpartum hemorrhage among the three groups(P>0.05). At the time points from T0 to T3, the VAS scores showed a downward trend in the three groups, and the VAS scores in the group B and the group C showed a more significant downward trend than those in the group A(P<0.05). At the time points from T1 to T3, the VAS scores in the group C were lower than those in the group B and the group C, and the differences were statistically significant(P<0.05). There were no significant differences in the modified Bromage scores among the three groups(P>0.05). There were no significant differences in birth weight, Apgar scores at the first minute, the fifth minute and the tenth minute, umbilical artery blood pH value, umbilical artery blood partial pressure of carbon dioxide(PCO2) and umbilical artery blood partial pressure of oxygen(PO2) among the three groups(P>0.05). Conclusion 0.3 μg/ml, 0.4 μg/ml, 0.5 μg/ml sufentanil combined with 0.1% ropivacaine can be safely and effectively applied in labor analgesia, among which 0.4 μg/ml sufentanil combined with 0.1% ropivacaine analgesia has little effect on labor and is recommended for clinical use. |
| Key words: Sufentanil Ropivacaine Labor analgesia Outcome |
