目的 探讨舒芬太尼复合罗哌卡因椎管内分娩镇痛对二次分娩孕产妇镇痛效果和产后发生抑郁症的影响。方法 纳入 2021 年 3 月—2023 年 3 月在我院二次分娩且经评估需要镇痛的孕产妇320 例作为研究对象,采用随机数字表法将患者分为对照组和观察组,每组各 160 例。观察组采用舒芬太尼复合罗哌卡因椎管内分娩镇痛,对照组不做分娩镇痛。观察两组视觉模拟疼痛评分（visual analogue score,VAS）、爱丁堡产后抑郁量表（Edinburgh postnatal depression scale,EPDS）评分、白介素 6（IL-6）、肿瘤坏死因子（TNF-α）水平、促肾上腺皮质激素（ACTH）、皮质醇（Cor）和不良反应发生率。结果 与对照组相比,观察组术后 6 h、12 h 和 24 h 的 VAS 分数都明显更低。两组患者术前EPDS 评分无明显差异,与对照组相比,观察组术后3 d、7d 和 30d 的EPDS分数更低,产后抑郁症的发生率更低（2.67% vs 8.00%）。两组患者术前IL-6和TNF-α水平无明显差异,与对照组相比,观察组术后6 h、12 h 和 24 h的IL-6和TNF-α水平更低。两组患者术前ACTH和Cor水平无明显差异,与对照组相比,观察组术后6 h ACTH和Cor水平更高。两组患者不良反应发生情况无明显差异。结论 舒芬太尼复合罗哌卡因椎管内分娩镇痛对二次分娩孕产妇中可以改善疼痛感、减轻抑郁症状、缓解应激状态和抑制炎症反应,值得临床推广。

Objective To explore the effects of sufentanil combined with ropivacaine for intrathecal labor analgesia on pain relief and the incidence of postpartum depression in women undergoing their second childbirth. Methods This study included 320 parturients who required analgesia for their second childbirth in our hospital from March 2021 to March 2023. They were randomly divided into a control group and an observation group,with 160 cases in each. The observation group received sufentanil combined with ropivacaine for intrathecal labor analgesia,while the control group did not receive any labor analgesia. The visual analog scale（VAS）scores,Edinburgh Postnatal Depression Scale（EPDS）scores,levels of interleukin 6（IL-6）,tumor necrosis factor（TNF-α）,adrenocorticotropic hormone（ACTH）,cortisol（Cor）,and the incidence of adverse reactions were observed in both groups. Results Compared with the control group,the VAS scores at 6h,12h,and 24h postoperatively were significantly lower in the observation group. There was no significant difference in the preoperative EPDS scores between the two groups;however,the EPDS scores at 3d,7d,and 30d postoperatively were lower in the observation group,as was the incidence of postpartum depression（2.67% vs 8.00%）. The levels of IL-6 and TNF-α preoperatively showed no significant difference between the groups,but were lower in the observation group at 6h,12h,and 24h postoperatively. There was no significant difference in the preoperative levels of ACTH and Cor between the two groups,but the levels were higher at 6h postoperatively in the observation group. The incidence of adverse reactions was not significantly different between the groups. Conclusion Sufentanil combined with ropivacaine for intrathecal labor analgesia in women undergoing second childbirth can improve pain perception,alleviate depressive symptoms,relieve stress,and inhibit inflammatory responses,and is worthy of clinical application.