低浓度布比卡因在无痛分娩中的应用

Clinical effect with low-dose bupivacaine for epidural labor analgesia

目的 观察产妇分娩时应用低浓度布比卡因复合芬太尼行硬膜外镇痛的临床效果。 方法 2 0 0例产妇随机分为自然分娩组 (对照组 )和布比卡因组 (试验组 )。试验组于宫口开 2 cm时行硬膜外镇痛。镇痛药为 1.2 5 g/ L布比卡因与 2 mg/L芬太尼的混合液 ,负荷量为 2 g/ L布比卡因 5～ 10 ml,持续量为 10 ml/ h泵入混合液 ,待宫口近开全时停药。监测两组产妇的生命体征 ,疼痛程度 ,下肢运动能力 ,宫缩感觉变化情况 ,产程及分娩结果等。 结果 镇痛效果 :试验组获得满意镇痛 ,与对照组相比有显著差异 (P<0 .0 1)。运动能力 :试验组产妇 48例下肢运动能力轻微下降 ,行走至产床时感觉腿软无力 ,对照组无上述现象 ,两组相比有显著差异 (P<0 .0 1)。感觉能力 :试验组 8例产妇在第二产程时失去排便感 ,与对照组相比有显著差异 (P<0 .0 1)。产程时间及分娩结果 :两组产程时间均在正常范围 ,组间无明显差异。 Apgar评分 5 min时均达到 10分。 结论 低浓度布比卡因可安全有效的应用于无痛分娩。

Objective To compare the effect of bupivacaine during epidual analgesia for the relief of labor pain. Methods 200 patients were randomly divided into two groups, Group A assigned to receive continuous epidural infusion(10 ml/h) of bupivacaine(1 g/L ), GroupB did not assign to receive epidural analgesia. Analgesia were initiated with a 5 ml test dose of 10 g/L lidocaine, followed by injections of 5～10 ml of 2 g/L bupivacaine. The continuous infusion were then started at 10 ml/h of 1.25 g/L bupivacaine. Pain relief was assessed by using a visual analog scale(VAS) and motor block was assessed by using a modified Bromage scale. Results Group A effectively decreased VAS ( P <0.01), and had minimal motor block at the end of the first stage of labor, Group B had no motor block vs group A ( P <0.01). Apgar scores and labor procedure were similar for two groups. Conclusion The 1.25 mg/ml bupivacaine can produce satisfactory labor analgesia at epidural infusion of 10 ml/h.