罗哌卡因复合芬太尼在分娩镇痛中的应用

Effect of ropivacaine with fentanly on analegesic labor

目的：观察低浓度罗哌卡因复合芬太尼对镇痛分娩的效果及对产程、母婴的影响.方法：选择280例足月单胎、产前检查无阴道分娩禁忌、无椎管内硬膜穿刺禁忌的初产妇.ASAⅠ～Ⅱ级,随机分为腰麻-硬膜外联合阻滞作为镇痛组,自然分娩组作为对照组,每组140例.镇痛组于产妇宫口开2～3cm时,取L2,3常规硬膜外穿刺,穿刺成功后,用腰麻针经硬膜外腔刺入蛛网膜下腔,见脑脊液回流通畅,缓慢注入0.2%罗哌卡因1.5ml（3mg）,拔除腰麻针,硬膜外腔向头侧置入硬膜外导管3.5cm,阻滞平面在T10以下,根据镇痛程度硬膜外腔每小时给予0.1%罗哌卡因6～8ml＋芬太尼2μg/ml,必要时追加3～5ml/15min.观察产妇的生命体征、镇痛效果（VAS评分）、下肢运动神经阻滞MBS（modified bromage score）、产程时间、产后出量、分娩方式、新生儿Apgar评分.结果：镇痛组产妇镇痛有效率100%,下肢运动神经阻滞轻,第一、二产程时间及产后出血量与对照组相比无显著差异（P＞0.05）,剖宫产率明显低于对照组的剖宫产率（P＜0.05）;两组新生儿Apgar评分均无统计学差异（P＞0.05）.结论：采用罗哌卡因复合和芬太尼的镇痛技术具有明显的镇痛作用,是目前分娩的理想方法.

Objective： To observe the labor pain relief effects of low concentration ropivacaine combined with fentany and its influences on the labor course. Methods： 280 parturients were randomly divided into 2 groups, who were no cunt tabu in labor or no tabu of spiking epidural, the combined epidural anesthesia as analgesia group,the natural labor as controlled group. In the analgesia group, the dilation of cervix was 2～3cm, the primiparae had the signs of monocysis fetal positions, ASAI-IL After spiking L2,3 epidual, the epidual cavity was put into subarachoid. If the waterhead flew back fluently, 0.2% ropicavaine was given 1.5ml （3mg）, and then pulled out the pin, the epidual cavity on the side of epidural catheter 3.5cm,the level under T10. According to the extent of analgesia, 0.1% ropivacain 6～8ml and fentany 2μg/ml were given. When it was necessary, 3～5ml was added per 15 min. The life character, analgesia score, the mode of delivery, labor course, bleeding volume and apgar score of newborn were observed. Results： The painless efficacy in analgesia group was 100%. The 2 processes and bleeding volume had no significant difference. The ratio of operation for labor was obviously lower than that of controlled group（P〈0.05）. There was no statistical difference between the two groups（P〉0.05）. Conclusion： Adopting ropicavaine and fentany has effect of pain relief, so it is a good way for labor.