罗哌卡因两种给药方案在分娩镇痛中的应用比较

COMPARATIVE EVALUATION OF TWO DIFFERENT INFUSIONS OF ROPIVACAINE FOR EPIDURAL LABOR ANALGESIA

目的 比较罗哌卡因 2种连续输注方案在产科硬膜外分娩镇痛中的应用。方法 60例产妇随即均分为A组和B组 ,两组于宫口开 2cm时行硬膜外镇痛 ,负荷量均为 0 . 2 %罗哌卡因 7～ 10ml。A组为 0 .1%罗哌卡因 (10ml/h) ,B组为0 2 %罗哌卡因 (5ml/h) ,同时分别加入 2mg/L芬太尼 ,待宫口近开全 (8～ 9cm)停药。检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 ,产程及分娩结果等。结果 2组均获得满意镇痛 ,两组满意度分别为 93 %、96%。运动能力 :两组产妇Bromega分级均未超过I级 ,但行走至产床时A组 5例 ,B组 7例感觉腿软无力 (P >0 . 0 1)。感觉能力 :两组对宫缩的感觉无明显下降 ,第二产程时均可良好的屏气用力 ,产钳助产率分别为 7%和 10 %。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。结论 罗哌卡因两种给药方案均可安全有效应用于无痛分娩。

Objective To assess 2 different continuous epidural infusions of ropivacaine for the relief of labor pain. Methods Sixty patients were randomly divided into 2 groups. Group A(n=30) and Group B(n=30). All patients were received a 5 ml test dose of 1% lidocaine, followed by 7～10 ml of 2 g/L ropivacaine. The continuous infusion started at 10 ml/h of 1 g/L ropivacaine combined with 2 mg/L fentanyl (group A) and 5 ml/h of 2 g/L ropivacaine combined with 2 mg/L fentanyl (group B). Pain relief was assessed by a visual analog scale (VAS) and motor block was assessed by a modified Bromage scale. Results VAS decreased and minimal or no motor block were discovered at the end of the first stage of labor (P>0.05) in both group A and group B. There is no difference of Apgar scores and labor procedure in 2 groups. Conclusions The 1 g/L and 2 g/L ropivacaine combined with 2 mg/L fentanyl can produce satisfactory labor analgesia at epidural infusion of 10 ml/h and 5 ml/h. Two different infusion of ropivacaine can provide the best combination of pain relief and motor block.