罗哌卡因硬膜外病人自控镇痛的无痛分娩效果及应激反应的研究

THE EFFECT OF PATIENT-CONTROLLED EPIDURAL ANALGESIA WITH ROPIVACAINE ON LABOR ANALGESIA AND STRESS REACTION

目的 :研究罗哌卡因的无痛分娩效果及对应激反应的影响。方法 :选开始进入活跃期的头位单胎初产妇 ,自愿接受无痛分娩的产妇作为试验组进行硬膜外镇痛 ,不愿接受无痛分娩的产妇作为对照组。试验组在硬膜外镇痛时随机分别接受 0 .1%的罗哌卡因 (R)或布比卡因 (B) ,30min后开启病人自控镇痛 (PCA)泵。观察镇痛效果、运动阻滞程度、分娩情况和新生儿情况 ,进行脐动脉血气分析 ,测定产妇血中皮质醇、血糖、胰岛素含量。结果 :试验组疼痛视觉模拟评分 (VAS)明显低于对照组 (P <0 .0 1) ,R组与B组之间没有差异 (P >0 .0 5 )。R组与B组之间下肢运动神经阻滞评分 (MBS)无显著性差异 (P >0 .0 5 ) ,但B组会阴侧切率高。对照组皮质醇、血糖、胰岛素 /血糖比值的变化最大 ,其次为B组 ,R组变化最小。结论 :PCEA下用 0 .1%R +1μg/mlF进行可行走的无痛分娩安全有效地抑制应激反应。

Objective: To study the effects of patient controlled epidural analgesia with ropivacaine for labor analgesia and stress reaction. Methods: Active stage full term parturients were divided into 2 groups: the volunteers who accepted labor analgesia were recruited as experimental group, while the parturients who refused labor analgesia were recruited as control group. The patients of experimental group received randomly with 0.1% ropivacaine(R)or bupivacaine(B) respectively and PCA pump after 30 min. We observed analgesia,motor block degree,time of labor course, fetal heart rate, labor mode, postpartum hemorrhage quantity, Apgar scores and determined pH, PO2, BE B level in the blood gas of umbilical artery and content of corticosteroid, sugar and insulin in blood. Results:There were significant differences ( P <0.01)in the pain visual analogue scale(VAS) between experimental and control group.There was no difference in VAS between group R and B. There was no difference in modified bromage score between group R and B, but the rate of lateral episiotomy was higher in group B.There were significant changes of corticosteroid in control group blood sugar, rate of insulin and blood sugar, and little change in experimental group. The changes in group B were greater than that in group R. Conclusion: 0.1% R+1μg/ml F for walking labor analgesia under PCEA can inhibite stress reaction effectively and safely.