舒芬太尼联合罗哌卡因在蛛网膜下隙-硬膜外隙联合分娩镇痛中的应用与评价

Effects of combined spinal-epidural analgesia with sufentanil and ropivacaine in women undergoing transvaginal analgesic delivery

摘要:

目的 探究舒芬太尼联合罗哌卡因蛛网膜下隙-硬膜外隙联合镇痛在经阴道分娩镇痛产妇中的应用效果。方法 选取2023年3月—2025年3月于保定市妇幼保健院行分娩镇痛的产妇126例，采用随机数字表法分为对照组（罗哌卡因蛛网膜下隙-硬膜外隙联合镇痛）和观察组（舒芬太尼联合罗哌卡因蛛网膜下隙-硬膜外隙联合镇痛），各63例。比较两组的产程时长，镇痛起效和持续时间，镇痛前（基线）、镇痛后5、15、30、60 min的视觉模拟评分法（VAS）评分，宫缩持续和间隔时间，新生儿结局（新生儿娩出后1、5 min进行Apgar评分），以及产妇不良反应发生率。结果 两组的年龄、体质量、孕周和美国麻醉医师协会（ASA）分级比较，差异均无统计学意义（P 0.05）。观察组第一、二、三产程时间均短于对照组（P 0.05）。观察组镇痛起效时间短于对照组，镇痛持续时间长于对照组（P 0.05）。两组镇痛前VAS评分比较，差异无统计学意义（P 0.05）。两组镇痛后5、15、30、60 min的VAS评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（P 0.05）；②观察组与对照组VAS评分比较，差异有统计学意义（P 0.05），观察组VAS评分较低，相对镇痛效果较好；③两组VAS评分变化趋势比较，差异有统计学意义（P 0.05）。两组宫缩持续时间、宫缩间隔时间比较，差异均无统计学意义（P 0.05）。两组1 min、5 min新生儿Apgar评分比较，差异均无统计学意义（P 0.05）。两组不良反应总发生率比较，差异无统计学意义（P 0.05）。结论 在经阴道分娩镇痛中，舒芬太尼联合罗哌卡因蛛网膜下隙-硬膜外隙联合镇痛可提供起效迅速、效果完善且作用持久的镇痛，并能显著缩短产程，且未对产妇宫缩模式、新生儿结局及产妇不良反应产生不利影响，整体安全性良好。

Abstract:

Objective To investigate the effects of combined spinal-epidural analgesia with sufentanil and ropivacaine in women undergoing transvaginal analgesic delivery.Methods A prospective randomized controlled trial was conducted. A total of 126 parturients who received analgesic delivery in our hospital between March 2023 and March 2025 were selected and randomly divided into a control group (combined spinal-epidural analgesia with ropivacaine) and an observation group (combined spinal-epidural analgesia with sufentanil and ropivacaine), with 63 cases in each group. The duration of labor stages, onset and duration of analgesia, Visual Analog Scale (VAS) before and at different time points after analgesia, duration and interval of uterine contractions, neonatal outcomes, and incidence of adverse reactions were compared between the two groups.Results The observation group and the control group showed no statistically significant differences in age, body weight, gestational age, or American society of anesthesiologists (ASA) classification (P 0.05). The durations of the first, second, and third stages of labor in the observation group were significantly shorter than those in the control group (P 0.05). The onset time of analgesia in the observation group was shorter than that in the control group, and its analgesic duration was longer (P 0.05). There was no statistically significant difference in VAS scores before analgesia between the observation group and the control group (P 0.05). At 5, 15, 30, and 60 minutes after analgesia: (1) VAS scores differed significantly across time points (P 0.05); (2) VAS scores differed significantly between the observation group and the control group (P 0.05), with the observation group showing lower scores, indicating relatively better analgesic efficacy; (3) The trends of VAS score changes differed significantly between the two groups (P 0.05). No statistically significant differences were observed between the observation group and the control group in the duration and interval of uterine contractions (P 0.05). The 1-minute and 5-minute Apgar scores showed no statistically significant differences between the observation group and the control group (P 0.05). The total incidence of adverse reactions did not differ significantly between the observation group and the control group (P 0.05).Conclusion In transvaginal analgesic delivery, combined spinal-epidural analgesia with sufentanil and ropivacaine can provide rapid-onset, complete, and long-lasting analgesia, significantly shorten the stages of labor, and shows no adverse effects on maternal uterine contraction patterns, neonatal outcomes, or the incidence of adverse reactions, demonstrating an overall favorable safety profile.