关键词: 腰-硬联合阻滞, 硬膜外阻滞, 分娩镇痛

Abstract: Objective To compare the analgesic effects of combined spinal-epidural anesthesia and epidural anesthesia, and their impacts on duration of labor, prenatal fever rate and fetal heart rate variability. Methods Six hundred and twenty-eight full-term nulliparous parturients were randomly assigned to receive combined spinal-epidural analgesia(group S)or epidural analgesia(group E)for labor analgesia with three hundred and forteen cases each.Another one hundred and sixty-eight nulliparous parturients without labor analgesia were taken as the controls group(group D). Group S:sufentanil 4 μg was injected intrathecally followed by epidural catheter placing at L3-4, patient controlled epidural infusion of 0.125% ropivacaine plus sufentanil 0.2 μg/mL was administered.Group E:Epidural catheter was placed at L2-3 interspace, 0.08 ropivacaine plus 0.5 μg/mL sufentanil was administered,which was followed by additional 10 mL injection. Patient controlled epidural infusion of 0.08% ropivacaine plus 0.5 μg/mL sufentanil was administered. Time of taking effect, pain scores, duration of each stage, incidence of prenatal fever rate, fetal heart rate variability, neonatal Apgar score, pruritus and other adverse effects were measured. Results VAS score of both group S and E were ≤3 points, time of taking effect of group S was significantly faster than the group E(P<0.05). Compared with group D, the duration of group S and E was shorter in first stage and significantly extended in second stage(P<0.05), however, there was significant difference among the three groups about the duration of the third stage. Compared with group D, the incidence of prenatal fever, fetal heart rate variability and pruritus were significant incresaed in both group S and E(P<0.05), further more the incidence in group S was higher than group E(P<0.05). However, there was no significant difference among three groups in neonatal Appar score and the incidence of nausea, vomiting, hypotension and respiratory depression(P>0.05). Conclusion Both combined spinal-epidural anesthesia and epidural anesthesia were effective labor analgesic techniques. Comparing with epidural anesthesia, combined spinal-epidural anesthesia has a shorter onset time and higher incidence of prenatal fever rate, fetal heart rate variability and pruritus.

Key words: combined spinal-epidural anesthesia, epidural anesthesia, labor analgesia