目的：评价不同剂量舒芬太尼复合罗哌卡因腰-硬联合阻滞在产程潜伏期分娩镇痛中的效果。方法选择2013年4~9月在北京美中宜和妇儿医院住院的80例单胎头位、ASAⅠ~Ⅱ级的初产妇为研究对象，随机、双盲分为R1组(3 mg罗哌卡因+3μg舒芬太尼)、R2组(3 mg罗哌卡因+4μg舒芬太尼)、R3组(3 mg罗哌卡因+5μg舒芬太尼)和R组(3 mg罗哌卡因)，共四组，每组20例。均于产程潜伏期(宫口开1 cm)行分娩镇痛。四组均采用0.1%罗哌卡因混合舒芬太尼0.5μg/mL行硬膜外自控镇痛(PCEA)。镇痛期间监测产妇生命体征和胎心率，记录镇痛情况、产程、催产素用量、分娩方式、阴道出血量、新生儿Apgar评分。结果四组产妇生命体征均在正常范围内波动；与镇痛前相比，四组镇痛期间疼痛数字评分(NRS)均降低(P<0.05)。随着舒芬太尼的剂量增加，镇痛起效、显效时间逐渐缩短(P<0.05)；首剂维持时间逐渐延长(P<0.05)。 R2、R3组潜伏期PCEA药物用量少于R组(P<0.05)；活>期PCEA药物用量四组间差异无统计学意义(P>0.05)。四组产妇产程、催产素用量、阴道出血量及分娩方式构成比、新生儿Apgar评分及体重比较差异无统计学意义(P>0.05)。R3组有5例产妇镇痛后出现胎心率下降(FHR≤100次/min)。镇痛期间R组瘙痒发生率低于其他三组(P<0.05)。R3组恶心发生率高于其他三组(P<0.05)；R2组产妇产后镇痛满意度优于其他三组。结论3 mg罗哌卡因复合舒芬太尼3~5μg蛛网膜下腔阻滞均可安全有效地用于产程潜伏期分娩镇痛。3 mg罗哌卡因复合舒芬太尼4μg蛛网膜下腔阻滞分娩镇痛，镇痛起效快，维持时间长，并发症的发生率低，产妇产后镇痛满意度高，临床应用具有一定优势。%Objective To evaluate the efficacy of spinal-epidural block with different doses of Sufentanil and Ropiva-caine for labor analgesia in latent phase. Methods 80 cases of patients with ASA Ⅰ or II primiparas with a singleton at full term in Beijing Amcare Hospital from April to September 2013 who were randomized into four groups, with 20 cases in each group, group R1 (Ropivacaine 3 mg plus Sufentanil 3 μg), group R2 (Ropivacaine 3 mg plus Sufentanil 4μg), group R3 (Ropivacaine 3 mg plus Sufentanil 5 μg) and the control group R (Ropivacaine 3 mg). Patients received labor analgesia in latent phase (at cervical dilatation of 1 cm). Patient controlled epidural infusion of 0.1% Ropivacaine plus Sufentanil 0.5 μg/mL was administered in four groups. The intensity of pain was evaluated by NRS score, and the motor function was assessed using modified Bromage score. The labor process, mode of delivery, fetal HR, uterine con-traction, postpartum hemorrhage, dosage of oxytocin, Apgar score of the neonates, maternal hemodynamics were record-ed. Results The maternal vital signs were fluctuated in the normal range. Compared with before analgesia, NRS scores in the four groups were all significantly reduced (P< 0.05). With the increasing of dosages of Sufentanil, the onset and working time of analgesia were reduced gradually (P<0.05), the lasting time of first dose was extended gradually (P<0.05). The dosages of PCEA consumed in latent phase of group R2 and R3 was less than that in group R (P<0.05). There were no significant differences in the dosages of PCEA consumed in active phase among the four groups (P >0.05). There were no significant differences in the stages of labor, dosages of oxytocin, vaginal amount of bleeding, constituent ratio of delivery mode, newborn Apgar scores and weight of the four groups (P> 0.05). There were 5 cases of FHR declined (FHR≤100 times/min) after loading dose in group R3. The incidence of skin pruritus in group R was lower than the other three groups (P<0.05). The incidence of nausea was higher in group R3 than the other three groups (P<0.05). Maternal satisfaction in group R2 was better than the other three groups. Conclusion Spinal-epidural block with Ropivacaine 3 mg plus Sufentanil 3-5μg for labor anal-gesia in latent phase is safe and effective. Ropivacaine 3 mg plus Sufentanil 4 μg is more suitable for labor analgesia with faster onset, longer hold time, lower incidence of complications and higher maternal satisfaction, which has some advantages in clinical application.
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