摘要目的 观察舒芬太尼复合罗哌卡因蛛网膜下腔和硬膜外联合麻醉分娩镇痛对新生儿的影响.方法 选择产科无椎管内麻醉及无阴道试产禁忌证的足月单胎头位初产妇100例,随机分为两组.Ⅰ组(n=50)产妇给予0.5 mg/L舒芬太尼联合0.1％罗哌卡因,蛛网膜下腔麻醉单次用药1.5 ml,硬膜外自控镇痛持续剂量5 ml/h,锁定时间15 min.Ⅱ组(n=50)产妇给予0.1％罗哌卡因,蛛网膜下腔麻醉单次用药1.5 ml,硬膜外自控镇痛持续剂量5 ml/h,锁定时间15 min.观察分娩镇痛效果,于分娩镇痛开始后10(T1)、30(T2)、60 min(T3)及120 min(T4)记录产妇镇痛评分(VAS评分),记录镇痛泵的进药容量、总按压次数(D1)/实际有效进药次数(D2)值.两组新生儿出生后即行血气分析,记录新生儿阿氏评分(Apgar),新生儿出生后连续5d进行新生儿神经行为评分(NBNA)及测定新生儿黄疸指数、体质量及血糖.结果 两组产妇T1～T4时点VAS评分的差异无统计学意义.D1/D2比值在T1、T2时点差异无统计学意义,而在T3、T4时点Ⅱ组高于Ⅰ组(2.5±1.0比1.5±0.9,2.8±1.2比2.1±0.6,均P＜0.05).镇痛泵的进药总量Ⅱ组也高于Ⅰ组[ (21.2±3.1) ml比(12±4.5) ml,P＜0.05].两组新生儿出生后5d内的NBNA、黄疸指数、生理性体质量下降幅度及血糖之间差异均无统计学意义.结论 0.5 mg/L舒芬太尼联合0.1％罗哌卡因蛛网膜下腔和硬膜外联合麻醉分娩镇痛可提供良好的镇痛效果,对新生儿具有良好的安全性.

abstractsObjective To investigate the effects of combined subarachnoid and epidural analgesia (CSEA) using sufentanil plus ropivacaine on neonates.Methods A total of 100 full term primiparae with singleton and cephalic presentation and without contraindications for intraspinal anesthesia or vaginal delivery were selected and randomly divided into two groups.Group Ⅰ (n=50) was given a mixture of 0.5mg/L sufentanil and 0.1％ ropivacaine for 1.5 ml single-dose subarachnoid anesthesia and 15 min 5 ml/h patient-controlled epidural analgesia; group Ⅱ (n=50) was given 0.1％ ropivacaine for 1.5 ml single-dose subarachnoid anesthesia and 15 min 5 ml/h patient-controlled epidural analgesia.The analgesic effects were then observed,and VAS scoring was recorded at 10 (T1),30(T2),60(T3)and 120 min(T4),as well as the drug volume in analgesia pump,the number of total press (D1)/number of practical and effective drug (D2).The blood gas analysis was immediately performed after the birth of neonates in two groups,and the Apgar score was recorded.The neurological assessment (NBNA),neonatal jaundice index,weight and blood sugar were determined in 5 consecutive days after birth of the neonates.Results There were no significant differences in VAS scoring during T1 to T4 between two groups of puerperas.The two groups showed no difference in D1/D2 ratio at T1 and T2,but group Ⅱ had a higher D1/D2 ratio than group Ⅰ at T3 and T4 (2.5±1.0 vs 1.5±0.9,2.8±1.2 vs 2.1±0.6,all P＜0.05).The total drug volume in analgesia pump in group Ⅱ was also higher than that in group Ⅰ [ (21.2±3.1)ml vs (12±4.5) ml,P＜0.05].No significant difference was found in NBNA,neonatal jaundice index,the decreased weight and blood sugar between the two groups of neonates within 5 d after birth.Conclusion CSEA using 0.5 mg/L sufentanil plus 0.1％ ropivacaine can provide the favorable analgesia efficacy for puerperas and safety for the neonates.