小剂量罗哌卡因联合舒芬太尼腰硬联合麻醉在无痛分娩中的应用
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摘要
目的探讨小剂量罗哌卡因联合舒芬太尼用于腰麻-连续硬膜外麻醉在无痛分娩应用的可行性与安全性。方法选择2016年5月—2017年5月间要求分娩镇痛的初产妇60例,ASAⅠ~Ⅱ级,宫口开2~3 cm,无椎管内麻醉禁忌证,无产科病理因素,随机双盲均分A组和B组,每组30例,A组产妇分娩镇痛应用腰麻-硬膜外麻醉组、B组产妇应用单纯硬膜外麻醉组,对比观察2组麻醉起效时间;改良Bromage评分;麻醉后3 min、5 min、10min、30 min、60 min VAS评分;产程情况;新生儿娩出后1 min及5 min Apgar评分;局麻药的用量;缩宫素使用情况;出血量;术中转剖宫产率及相关并发症等。结果 A组麻醉起效时间[(3.2±1.4)min]显著短于B组[(6.3±3.5)min],A组麻醉后3 min、5 min、10 min、30 min、60 min VAS评分分别为(3.2±1.3)、(2.3±1.1)、(1.5±0.4)、(1.2±0.6)、(1.8±0.5)分,均低于B组[(7.3±1.7)、(6.6±1.3)、(4.5±0.6)、(1.7±0.5)、(3.6±1.2)分(均P<0.05)],A组局麻药的用量为(9.5±4.7)mg,显著少于B组[(18.9±8.3)mg(P<0.05)],A组中转剖宫产率为6.7%,显著低于B组[26.7%(P<0.05)],但A组皮肤瘙痒发生率较B组高(P<0.05),2组其他指标差异无统计学意义(P>0.05)。结论小剂量罗哌卡因联合舒芬太尼用于分娩镇痛,腰硬联合麻醉组起效快,镇痛效果满意,用药量少,是无痛分娩较为理想的麻醉方式。
Objective To investigate the feasibility and safety of low-dose Ropivacaine combined Sufentanil on combined spinal anesthesia in painless childbirth. Methods Sixty primipara requiring analgesia childbirth with ASA of Ⅰ-Ⅱ,uterus opening of 2-3 cm,no contraindications to spinal anesthesia,and no obstetric pathological factors from May,2016 to May,2017 were selected and divided into group A and group B by randomized double-blind method,with 30 cases in each group. Group A was given combined spinal-epidural anesthesia( CSEA) in painless childbirth,while group B was given epidural anesthesia in painless childbirth. The anesthesia onset time,improved Bromage score,VAS score at 3min,5 min,10 min,30 min,60 min after anesthesia,birth process,neonatal Apgar score at 1 min and 5 min after delivery,anesthetic amount,oxytocin using,bleeding,intraoperative cesarean section rate,and related complications of the two groups were compared. Results The anesthesia onset time of group A was( 3. 2 ± 1. 4) min,which was significantly shorter than that of group B( 6. 3 ± 3. 5) min. The VAS scores of group A at 3,5,10,30 and 60 minutes after anesthesia were( 3. 2 ± 1. 3),( 2. 3 ± 1. 1),( 1. 5 ± 0. 4),( 1. 2 ± 0. 6) and( 1. 8 ± 0. 5),respectively,which were lower than those of group B( 7. 3 ± 1. 7),( 6. 6 ± 1. 3),( 4. 5 ± 0. 6),( 1. 7 ± 0. 5) and( 3. 6 ± 1. 2),P < 0. 05. The local anesthetic dosage of group A was( 9. 5 ± 4. 7) mg,which was significantly lower than that of group B( P < 0. 05).The cesarean section rate of group A was 6. 7%,which was significantly lower than that of group B 26. 7%( P < 0. 05).But the skin pruritus incidence of in group A was higher than that of group B( P < 0. 05),there were no significant difference in other index between the two groups( P > 0. 05). Conclusion The combined spinal-epidural anesthesia with low-dose Ropivacaine combined Sufentanil for painless childbirth had the advantage of rapid onset,analgesic satisfactory and less dosage,and was an ideal anesthetic mode for painless childbirth.
Objective To investigate the feasibility and safety of low-dose Ropivacaine combined Sufentanil on combined spinal anesthesia in painless childbirth. Methods Sixty primipara requiring analgesia childbirth with ASA of Ⅰ-Ⅱ,uterus opening of 2-3 cm,no contraindications to spinal anesthesia,and no obstetric pathological factors from May,2016 to May,2017 were selected and divided into group A and group B by randomized double-blind method,with 30 cases in each group. Group A was given combined spinal-epidural anesthesia( CSEA) in painless childbirth,while group B was given epidural anesthesia in painless childbirth. The anesthesia onset time,improved Bromage score,VAS score at 3min,5 min,10 min,30 min,60 min after anesthesia,birth process,neonatal Apgar score at 1 min and 5 min after delivery,anesthetic amount,oxytocin using,bleeding,intraoperative cesarean section rate,and related complications of the two groups were compared. Results The anesthesia onset time of group A was( 3. 2 ± 1. 4) min,which was significantly shorter than that of group B( 6. 3 ± 3. 5) min. The VAS scores of group A at 3,5,10,30 and 60 minutes after anesthesia were( 3. 2 ± 1. 3),( 2. 3 ± 1. 1),( 1. 5 ± 0. 4),( 1. 2 ± 0. 6) and( 1. 8 ± 0. 5),respectively,which were lower than those of group B( 7. 3 ± 1. 7),( 6. 6 ± 1. 3),( 4. 5 ± 0. 6),( 1. 7 ± 0. 5) and( 3. 6 ± 1. 2),P < 0. 05. The local anesthetic dosage of group A was( 9. 5 ± 4. 7) mg,which was significantly lower than that of group B( P < 0. 05).The cesarean section rate of group A was 6. 7%,which was significantly lower than that of group B 26. 7%( P < 0. 05).But the skin pruritus incidence of in group A was higher than that of group B( P < 0. 05),there were no significant difference in other index between the two groups( P > 0. 05). Conclusion The combined spinal-epidural anesthesia with low-dose Ropivacaine combined Sufentanil for painless childbirth had the advantage of rapid onset,analgesic satisfactory and less dosage,and was an ideal anesthetic mode for painless childbirth.
引文
[1]李正伟.腰硬联合麻醉与硬膜外麻醉在分娩镇痛中合理运用[J].医药前沿,2016,6(7):90-91.
[2]梁富华,裴润萍,罗婕好,等.盐酸罗哌卡因联合舒芬太尼硬膜外麻醉无痛分娩临床观察[J].中国卫生产业,2014,11(8):179-180.
[3]刘明华.腰麻-硬膜外联合阻滞麻醉在分娩镇痛中的应用效果[J].按摩与康复医学,2014,5(11):102-103.
[4]王雅聪,李淑丽,陈晓明.腰麻-硬膜外联合麻醉用于分娩潜伏期延长产妇镇痛的临床研究[J].实用临床医药杂志,2017,21(15):92-94.
[5]陆冬梅.罗哌卡因复合芬太尼用于初产妇无痛分娩对母婴的影响[J].河北医药,2015,37(19):2968-2970.
[6]唐楠,孟庆朝,杜平均,等.腰硬联合麻醉分娩镇痛的临床分析[J].心理医生,2016,22(26):189-190.
[7]Ding T,Wang DX,Qu Y.Epidural labor analgesia is associated with adecreased risk of postpartum:A prospective cohort study[J].Anesth Analg,2014,119(2):383-392.
[8]周金彩,吴春秀,张乐,等.小剂量罗哌卡因复合舒芬太尼腰硬联合麻醉用于无痛分娩对母婴结局的影响[J].临床合理用药,2016,9(2A):43-45.
[9]刘光辉.腰麻联合硬膜麻醉与硬膜外麻醉在分娩镇痛中应用的价值对比[J].实用妇科内分泌杂志,2016,3(21):71-73.
[10]朱美玉,许荣海,陈萍萍,等.罗哌卡因复合舒芬太尼在分娩镇痛的应用[J].中外医学研究,2017,15(1):113-114.
[11]韦毅勤.无痛分娩对初产妇分娩结局和泌乳功能的重要性探讨[J].中外医疗,2014,33(6):88-89.
[12]王晓光,李戈辉,齐晓非.不同质量浓度舒芬太尼复合罗哌卡因在分娩孕妇镇痛效果的比较[J].浙江临床医学,2016,18(7):1346-1347.
[13]吴桃云,黄伟坚,刘燕.舒芬太尼用于无痛分娩对新生儿窒息率的影响[J].中国现代药物应用,2015,9(7):119-121.
[14]耿翠霞,高娜,白晓蔚,等.潜伏期罗哌卡因联合舒芬太尼分娩镇痛对孕妇分娩结局的影响[J].临床医药文献电子杂志,2017,4(33):6492-6493.
[15]方萌,李静静,李红军,等.舒芬太尼复合罗哌卡因用于瘢痕子宫产妇可行走硬膜外镇痛效果观察[J].中国医师杂志,2015,21(z1):101-102.
[16]张彩玲,陈伟元.不同剂量舒芬太尼复合罗哌卡因腰麻在高龄患者手术中的应用[J].海南医学,2014,25(7):977-979.
[17]高利洁,向军,刘菁,等.低浓度布比卡因复合芬太尼腰硬联合麻醉在分娩镇痛中的应用[J].麻醉与镇痛,2010,7(27):63-66.
[2]梁富华,裴润萍,罗婕好,等.盐酸罗哌卡因联合舒芬太尼硬膜外麻醉无痛分娩临床观察[J].中国卫生产业,2014,11(8):179-180.
[3]刘明华.腰麻-硬膜外联合阻滞麻醉在分娩镇痛中的应用效果[J].按摩与康复医学,2014,5(11):102-103.
[4]王雅聪,李淑丽,陈晓明.腰麻-硬膜外联合麻醉用于分娩潜伏期延长产妇镇痛的临床研究[J].实用临床医药杂志,2017,21(15):92-94.
[5]陆冬梅.罗哌卡因复合芬太尼用于初产妇无痛分娩对母婴的影响[J].河北医药,2015,37(19):2968-2970.
[6]唐楠,孟庆朝,杜平均,等.腰硬联合麻醉分娩镇痛的临床分析[J].心理医生,2016,22(26):189-190.
[7]Ding T,Wang DX,Qu Y.Epidural labor analgesia is associated with adecreased risk of postpartum:A prospective cohort study[J].Anesth Analg,2014,119(2):383-392.
[8]周金彩,吴春秀,张乐,等.小剂量罗哌卡因复合舒芬太尼腰硬联合麻醉用于无痛分娩对母婴结局的影响[J].临床合理用药,2016,9(2A):43-45.
[9]刘光辉.腰麻联合硬膜麻醉与硬膜外麻醉在分娩镇痛中应用的价值对比[J].实用妇科内分泌杂志,2016,3(21):71-73.
[10]朱美玉,许荣海,陈萍萍,等.罗哌卡因复合舒芬太尼在分娩镇痛的应用[J].中外医学研究,2017,15(1):113-114.
[11]韦毅勤.无痛分娩对初产妇分娩结局和泌乳功能的重要性探讨[J].中外医疗,2014,33(6):88-89.
[12]王晓光,李戈辉,齐晓非.不同质量浓度舒芬太尼复合罗哌卡因在分娩孕妇镇痛效果的比较[J].浙江临床医学,2016,18(7):1346-1347.
[13]吴桃云,黄伟坚,刘燕.舒芬太尼用于无痛分娩对新生儿窒息率的影响[J].中国现代药物应用,2015,9(7):119-121.
[14]耿翠霞,高娜,白晓蔚,等.潜伏期罗哌卡因联合舒芬太尼分娩镇痛对孕妇分娩结局的影响[J].临床医药文献电子杂志,2017,4(33):6492-6493.
[15]方萌,李静静,李红军,等.舒芬太尼复合罗哌卡因用于瘢痕子宫产妇可行走硬膜外镇痛效果观察[J].中国医师杂志,2015,21(z1):101-102.
[16]张彩玲,陈伟元.不同剂量舒芬太尼复合罗哌卡因腰麻在高龄患者手术中的应用[J].海南医学,2014,25(7):977-979.
[17]高利洁,向军,刘菁,等.低浓度布比卡因复合芬太尼腰硬联合麻醉在分娩镇痛中的应用[J].麻醉与镇痛,2010,7(27):63-66.