不同浓度罗哌卡因复合舒芬太尼在硬膜外镇痛分娩中的效果评价
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摘要
目的探讨不同浓度罗哌卡因复合舒芬太尼在无痛分娩中的应用效果。方法选取产妇200例,按照随机数字表法分为A组(n=67)、B组(n=67)、C组(n=66)。A组采用0. 08%罗哌卡因+0. 5μg/m L舒芬太尼,B组采用0. 10%罗哌卡因+0. 5μg/m L舒芬太尼,C组采用0. 15%罗哌卡因+0. 5μg/m L舒芬太尼。比较各组产妇的镇痛效果及分娩情况。结果镇痛后5 min、30 min、1 h以及分娩即刻时,A组VAS评分均显著高于B组和C组(P <0. 05)。3组产妇运动神经阻滞Bromage评级情况比较,A组和B组的Bromage评级显著优于C组(P <0. 05)。3组产妇第一、二、三产程时间以及3组新生儿出生后1、5、10 min的Apgar评分比较均无显著差异(P> 0. 05)。结论 0. 10%罗哌卡因复合0. 5μg/m L舒芬太尼应用于无痛分娩中镇痛效果最优,安全性最高,可作为无痛分娩硬膜外麻醉的推荐剂量。
Objective To explore the effect of different concentrations of ropivacaine combined with sufentanil on treatment of patients with painless delivery. Methods A total of 200 pregnant women were selected and randomly divided into group A(n = 67),group B(n = 67) and group C(n = 66). The group A was treated with 0. 08% ropivacaine plus 0. 5 μg/m L sufentanil,the group B was treated with 0. 10% ropivacaine plus 0. 5 μg/m L sufentanil,and the group C was treated with0. 15% ropivacaine plus 0. 5 μg/m L sufentanil. The analgesic effect and delivery condition were compared among three groups. Results The VAS score of group A was significantly higher than that of group B and group C at 5 min,30 min,1 hour after analgesia and immediately after delivery(P <0. 05). The Bromage rating of group A and group B was significantly better than that of group C(P <0. 05). There were no significant differences in the durations of the first,second and third stages of labor and the Apgar scores at 1,5 and 10 minutes after birth among the three groups(P > 0. 05).Conclusion 0. 10% ropivacaine combined with 0. 5 μg/m L sufentanil has the best analgesic effect and the highest safety in painless delivery,and it can be used as the recommended dose for painless delivery by epidural anesthesia.
Objective To explore the effect of different concentrations of ropivacaine combined with sufentanil on treatment of patients with painless delivery. Methods A total of 200 pregnant women were selected and randomly divided into group A(n = 67),group B(n = 67) and group C(n = 66). The group A was treated with 0. 08% ropivacaine plus 0. 5 μg/m L sufentanil,the group B was treated with 0. 10% ropivacaine plus 0. 5 μg/m L sufentanil,and the group C was treated with0. 15% ropivacaine plus 0. 5 μg/m L sufentanil. The analgesic effect and delivery condition were compared among three groups. Results The VAS score of group A was significantly higher than that of group B and group C at 5 min,30 min,1 hour after analgesia and immediately after delivery(P <0. 05). The Bromage rating of group A and group B was significantly better than that of group C(P <0. 05). There were no significant differences in the durations of the first,second and third stages of labor and the Apgar scores at 1,5 and 10 minutes after birth among the three groups(P > 0. 05).Conclusion 0. 10% ropivacaine combined with 0. 5 μg/m L sufentanil has the best analgesic effect and the highest safety in painless delivery,and it can be used as the recommended dose for painless delivery by epidural anesthesia.
引文
[1]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.
[2]房建,赵继蓉.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[J].中华全科医学,2018,16(2):264-267.
[3] Ding T,Wang D X,Qu Y. Epidural labor analgesia is associated with adecreased risk of postpartum:A prospective cohort study[J]. Anesth Analg,2014,119(2):383-392.
[4]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.
[5]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.
[6]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):346-1347.
[7]赵东芳,王贺东.小剂量罗哌卡因复合舒芬太尼腰硬联合分娩镇痛的临床观察[J].临床和实验医学杂志,2018,17(10):1116-1119.
[8] Shnol H,Paul N,Belfer I. Labor pain mechanisms[J]. Int Anesthesiol Clin,2014,52(3):1-17.
[9] Booth J M,Pan J C,Ross V H,et al. Combined Spinal Epidural Technique for Labor Analgesia Does Not Delay Recognition of Epidural Catheter FailuresA Single-center Retrospective Cohort Survival Analysis[J]. Anesthesiology,2016,125(3):516-524.
[10] Dourado A D,Filho R L,Fernandes R A,et al. Sufentanil in combination with low-dose hyperbaric bupivacaine in spinal anesthesia for cesarean section:a randomized clinical trial[J]. Braz J Anesthesiol,2016,66(6):622-627.
[11]纪淑敏.不同浓度罗哌卡因配伍舒芬太尼用于产妇分娩镇痛的临床效果观察[J].中国计划生育学杂志,2017,25(5):323-327.
[12] Stroumpoulis K,Stamatakis E,Koutroumanis P,et al. Pencilpoint needle bevel direction influences ED50 of isobaric ropivacaine with fentanyl in spinal anesthesia for cesarean delivery:a prospective,double-blind sequential allocation study[J]. Int J Obstet Anesth,2015,24(3):225-229.
[13] Lacour J P,Ulrich C,Gilaberte Y,et al. Daylight photodynamic therapy with methyl aminolevulinate cream is effective and nearly painless in treating actinic keratoses:a randomised, investigator-blinded, controlled, phaseⅢstudy throughout europe[J]. J Eur Acad Dermatol Venereol,2015,74(2):262-269.
[14]宗银东,聂颖,姜义铁,等.罗哌卡因硬膜外患者自控镇痛的无痛分娩效果及应激反应的临床研究[J].重庆医学,2016,45(17):2407-2409.
[15]刘国华,韦天全.舒芬太尼复合不同剂量罗哌卡因蛛网膜下腔阻滞在产程潜伏期分娩镇痛中的应用[J].中国妇幼保健,2016,31(10):2068-2070.
[2]房建,赵继蓉.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[J].中华全科医学,2018,16(2):264-267.
[3] Ding T,Wang D X,Qu Y. Epidural labor analgesia is associated with adecreased risk of postpartum:A prospective cohort study[J]. Anesth Analg,2014,119(2):383-392.
[4]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.
[5]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.
[6]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):346-1347.
[7]赵东芳,王贺东.小剂量罗哌卡因复合舒芬太尼腰硬联合分娩镇痛的临床观察[J].临床和实验医学杂志,2018,17(10):1116-1119.
[8] Shnol H,Paul N,Belfer I. Labor pain mechanisms[J]. Int Anesthesiol Clin,2014,52(3):1-17.
[9] Booth J M,Pan J C,Ross V H,et al. Combined Spinal Epidural Technique for Labor Analgesia Does Not Delay Recognition of Epidural Catheter FailuresA Single-center Retrospective Cohort Survival Analysis[J]. Anesthesiology,2016,125(3):516-524.
[10] Dourado A D,Filho R L,Fernandes R A,et al. Sufentanil in combination with low-dose hyperbaric bupivacaine in spinal anesthesia for cesarean section:a randomized clinical trial[J]. Braz J Anesthesiol,2016,66(6):622-627.
[11]纪淑敏.不同浓度罗哌卡因配伍舒芬太尼用于产妇分娩镇痛的临床效果观察[J].中国计划生育学杂志,2017,25(5):323-327.
[12] Stroumpoulis K,Stamatakis E,Koutroumanis P,et al. Pencilpoint needle bevel direction influences ED50 of isobaric ropivacaine with fentanyl in spinal anesthesia for cesarean delivery:a prospective,double-blind sequential allocation study[J]. Int J Obstet Anesth,2015,24(3):225-229.
[13] Lacour J P,Ulrich C,Gilaberte Y,et al. Daylight photodynamic therapy with methyl aminolevulinate cream is effective and nearly painless in treating actinic keratoses:a randomised, investigator-blinded, controlled, phaseⅢstudy throughout europe[J]. J Eur Acad Dermatol Venereol,2015,74(2):262-269.
[14]宗银东,聂颖,姜义铁,等.罗哌卡因硬膜外患者自控镇痛的无痛分娩效果及应激反应的临床研究[J].重庆医学,2016,45(17):2407-2409.
[15]刘国华,韦天全.舒芬太尼复合不同剂量罗哌卡因蛛网膜下腔阻滞在产程潜伏期分娩镇痛中的应用[J].中国妇幼保健,2016,31(10):2068-2070.