不同局麻药用于分娩镇痛的对比观察

A Comparison of Analgesic Effects Among Different Local Anesthetics in Labor Pain Relief

目的 :研究低浓度罗哌卡因、布比卡因、利多卡因加小剂量芬太尼用于病人自控硬膜外分娩镇痛 (PCEA)的临床效果。方法 :2 70例单胎、足月、头位、初产妇随机分成三组 :Ⅰ组 0 2 %罗哌卡因 ,Ⅱ组 0 12 5 %布比卡因 ,Ⅲ组0 4 %利多卡因 ,均加 0 0 0 2 %芬太尼配成镇痛混合液 ,按LCP[负荷剂量 (L)、持续注入剂量 (C)、病人自控剂量 (P) ]给药模式实施无痛分娩。观察镇痛效果 [视觉模拟评分 (VAS) ]、运动能力 [医疗研究理事会评分 (MRC) ]、行走状况、产程时间、分娩方式以及副作用的发生。结果 :全组病人均获得满意的镇痛效果 ,VAS评分镇痛后明显降低 ,与镇痛前相比有显著差异 (P <0 0 1)。Ⅰ组MRC评分、产妇第一产程行走率、自然分娩率均高于Ⅱ、Ⅲ组 ,组间相比有显著差异(P <0 0 1)。Ⅰ组第二产程时间明显缩短 ,与Ⅱ、Ⅲ组相比有显著差异 (P <0 0 1)。全组产妇产程中没有发生并发症和其他不良反应。结论 :低浓度罗哌卡因是较理想的分娩镇痛局麻药。

Objective:To study the efficacy of low concentrations of ropivacaine,bupivacaine,and lidocaine,plus low does of fentanyl respectively in self-controlled epidural analgesia for delivery. Methods:There were 270 primiparae with single,full-term and head-down position fetus randomly divided into three groups.Group one were treated with 0.2% ropivacaine,group two with 0.125% bupivacaine,group three with 0.4% lidocaine,and 0.002% fentanyl was added to each of the three anesthetics to make a mixed analgesic solution,which was administered in the manner of LCP[load does (L),continuous infusien does (C),self-controlled dose(P)] during pain-free delivery. Analgesic effects [visual analogue scales(VAS)],motor ability medical research council scores(MRC),walking status,labour time,labour manner,and side effects were observed. Results:Satisfactory analgesic effects were achieved in all parturien,and VAS scores were significantly reduced after analgesia had been practiced(P<0.01).MRC scores,walking rate of parturien in the first stage of labor and rate of natural labour were significantly higher in the first group than the second and third group(P<0.01).The time of the second stage of labor in the first group was significantly shorter than that in the second and third groups(P<0.01). No complications and side effects were observed in all parturien during the three stages of labour. Conclusion:Low concentration of ropivacaine is a satisfactory local anesthetic for analgesic birth.