罗派卡因与布比卡因应用于分娩镇痛的临床观察

Clinical observation of ropivacaine and bupivacaine for labor analgesia

目的 :观察硬膜外分娩镇痛应用罗派卡因和布比卡因的效果和安全性及对产妇和胎儿的影响。方法 :选择单胎足月初产妇ASA1～2级要求分娩镇痛者随机分成使用罗派卡因组 (R组 )75例 ,使用布比卡因组 (B组 )85例 ,另随机选择不予镇痛自然分娩产妇为对照组 (D组 )120例。观察镇痛效果VAS评分、运动阻滞程度Bromage法 ,生命体征、胎心率、产后出血量、Apgar评分、产程、分娩方式。结果 :R组与B组生命体征平稳 ,胎心率、产后出血量、Apgar评分、分娩方式比较差异无显著性 (P>0.05) ,R与B组镇痛效果确切,用药前后与D组比较差异均有显著性 (P<0.05)。B组运动阻滞程度明显高于其它两组P<0.01,第一产程和第二产程虽延长 ,但均未超过常规时间。结论 :罗派卡因和布比卡因应用于硬膜外镇痛分娩是有效安全的方法 ,但罗派卡因更优于布比卡因。

Objective:To investigate the effect and safety of epidural labor analgesia with ropivacaine and bupivacaine.Methods:75 patients with full term primipara at ASA 1～2 were administered epidural labor analgesia with ropivacaine during labor(group R),85 with bupivacaine(group B) and 120 were spontaneous labor as the control(group D).When the ostium uteri was dilated to 2～3 cm,the epidural puncture was performed at L2～3 interspace with 1% lidocaine 3 ml by infusion as a experimental dose.In the group R,0.25% ropivacaine 5～10 ml was injected into epidural space,which was added on PCEA with 0.125% ropivacaine and fentanyl(2 μg/ml) after 30 minutes(backgroud infusion 5 ml/h,single dose locking up time 20 munutes).In the group B ropivacaine was superseded by bupivacaine.The effect of analgesia(VAS score),degree of motor block(modified Bromage score),vital signs,fetal heart rate,capacity of postpartum hemorrhage,Apgar score,duration of laboure and mode of delivery were recorded and compared.Results:The vital signs in the group R and B were stable.The were no differences in Apgar score,fetal heart rate,capacity of postpartum hemorrhage and mode of delivery among three groups(P>0.05).The effect of analgesia in the group R and B was definite,the difference was significant before and after administration and also significant compared with the group D(P<0.05).The degree of motor block in the group R was less than that in the group B(P<0.01).The first and the second duration of labour in the group R and B were prolonged,but it did not exceed the routine time.Conclusion:The epidural labor analgesia with ropivacaine and bupivacaine provides a satisfactory analgesia during labor and is effective and safe for both mother and infant,but the ropivacaine is superior to bupivacaine.