硬膜外腔持续输注0.125%罗哌卡因用于分娩镇痛对产程的影响

The effect of continuous epidural infusion of 0.125% ropivacaine on the progress of labor

目的 探讨硬膜外腔持续输注 0 .12 5 %罗哌卡因对产妇分娩产程的影响。方法 2 0例自然足月初产妇 ,ASAⅠ级 ,单胎 ,头位 ,志愿要求行硬膜外分娩镇痛者作为镇痛组。行L2～ 3 硬膜外穿刺 ,向头端置管 4cm ,当产妇进入宫缩活跃期 ,宫口开至 3cm时 ,经硬膜外导管注入 0 .2 %罗哌卡因 5～ 10ml,控制感觉阻滞平面 <T8,接一次性微量输入泵 ,泵速为 4ml/hr ,第二产程结束时停用 ,镇痛泵内含 0 .12 5 %罗哌卡因和 2 μg/ml芬太尼。对照组 2 0例产妇按产科常规处理。在分娩过程中需要观察以下项目 :①两组产妇VAS评分 ;②催产素的使用率 ;③第一、第二及总产程时间 ;④产妇出血量及新生儿 1min和 5minApgar评分。 结果 ①镇痛组产妇给药前VAS评分为9.6 0± 0 .5 0 ,给药后第一产程、第二产程分别为 1.6 0± 1.10、1.6 5± 0 .93,第一、二产程与给药前相比差异非常显著 ,P <0 .0 1。对照组第一、二产程VAS评分分别为 9.75± 0 .4 4、9.80± 0 .4 1,两者相比无差异 ,P >0 .0 5。②镇痛组产妇催产素的使用率 6 0 .0 % ,对照组 2 5 .0 % ,两者相比差异非常显著 ,P <0 .0 5。③镇痛组与对照组第一、三产程时间相比无差异性 ,P >0 .0 5。而两组第二产程时间相比 ,P <0 .0 1。结论 硬膜外腔持续输入 0 .12 5

Objective To investigate the effect of continuous epidural infusion of 0.125% ropivacaine on the progress of labor. Methods Twenty ASA-I full-term primigravidae were performed epidural puncture at L- 2-3. When the external cervical os was dilated to 3 cm,about 5～10 ml of 0.2% ropivacaine was injected into epidural space,sensory block level was controlled under T-8,then epidural analgesia pump with 0.125% ropivacaine and 2 μg/ml fentanyl was started(4 ml/hr) . The controlled subjects were received as obstetrical routine. Results VAS of pre-administration of analgesia group was 9.60±0.50,the first and second progress of labor of post- administration were 1.60±1.10、1.65±0.93 respectively. VAS of post-administration as compared with pre-administration showed significant difference (P<0.01). The rate of use oxytocin and the duration in second progress of analgesia group were significantly more different than the controlled group. The first、third and total progress of labor,the amount of bleeding,Apgar score at 1 min and 5 min time split presented no significant differences in two groups. Conclusion Continuous epidural infusion of 0.125% ropivacaine has slight effect on progress of labor,which can be rectified by infusion of oxytocin in the first progress of labor. But when the second progress of labor is involved,assisting delivery is needed.