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目的探讨0.125%罗哌卡因复合舒芬太尼用于潜伏期分娩镇痛的效果及对子宫收缩力的影响及新生儿阿氏评分情况。方法选择60例Ⅰ~Ⅱ级的足月初产妇,其中要求施行分娩镇痛的30例为观察组,另30例为对照组。观察组在进入产程潜伏期后进行腰-硬联合穿刺,见脑脊液流出后,缓慢注入小剂量的舒芬太尼20~25μg于蛛网膜下腔作为负荷剂量,300 min后连接PCA泵以0.125%罗哌卡因1000 ml与舒芬太尼50μg混合给予配制好的药液,胎儿娩出后停止硬膜外腔给药;对照组按产科常规处理。观察镇痛起效时间,子宫收缩力的变化,总产程、产后出血量、分娩结局及新生儿阿氏评分。结果观察组与对照组相比总产程无差异。第一产程中观察组于对照组相比子宫收缩力显著降低,P<0.05,催产素使用率在80%以上。两组间产后出血、新生儿阿氏评分无显著差异。结论舒芬太尼合并低浓度的罗哌卡因应用于无痛分娩,有明显的分娩镇痛作用,镇痛效果确切,不影响产程及新生儿,不增加难产的比例不增加产后出血量,对新生儿的阿氏评分无影响。
Objective To investigate the effect of 0.125% ropivacaine combined with sufentanil on latent analgesia in labor and its effect on uterine contractility and neonatal Asperger’s score. Methods Sixty primiparous term women of grade Ⅰ ~ Ⅱ were selected. Among them, 30 cases requiring labor analgesia as observation group and the other 30 cases as control group. The observation group was subjected to lumbar-hard joint puncture after entering the labor latency. After the cerebrospinal fluid was excreted, a small dose of 20-25 μg of sufentanil was slowly injected into the subarachnoid space as the loading dose. After 300 min, PCA pump was connected with 0.125% 1000 ml of piopamine and sufentanil 50 μg were given to the prepared solution, and the epidural administration was stopped after the fetus was delivered. The control group was routinely obeyed by obstetrics. Observation of analgesic onset time, changes in uterine contractility, total labor, postpartum hemorrhage, delivery outcomes and neonatal Asperger score. Results There was no difference in total labor between observation group and control group. The observation group in the first stage of labor in the control group compared to significantly lower uterine contractility, P <0.05, oxytocin use rate above 80%. Postpartum hemorrhage between the two groups, neonatal Ah’s score no significant difference. Conclusion Sufentanil combined with low concentration of ropivacaine for painless childbirth has obvious labor analgesic effect, analgesic effect is exact, does not affect the birth process and newborns, do not increase the proportion of dystocia does not increase the amount of postpartum hemorrhage, No impact on newborn’s Alzheimer’s score.