罗哌卡因与布比卡因硬膜外自控镇痛用于分娩镇痛的比较

Comparison of ropivacaine with bupivacaine use in PCEA for labor analgesia

目的比较罗哌卡因与布比卡因硬膜外自控镇痛(PCEA)用于分娩镇痛的效果及对产程的影响。方法300例单胎足月初产妇随机分为两组,每组150例。两组在硬膜外镇痛时分别接受罗哌卡因或布比卡因行PCEA。观察两组镇痛效果、运动阻滞程度、分娩情况和新生儿情况,进行脐动静脉血气分析。结果两组镇痛效果良好,两组疼痛视觉模拟评分(VAS)差异不显著(P>0.05),两组对产程、新生儿Apgar评分、阴道助产率、剖宫产率及催产素的使用率影响差异不显著(P>0.05)。但布比卡因组对运动神经的阻滞程度显著增高,差异有显著性(P<0.05)。结论低浓度罗哌卡因PCEA用于分娩镇痛,效果完善,比低浓度布比卡因PCEA运动阻滞更轻微。

Objective： To compare the efficacy of ropivacaine with bupivacaine used by patient controlled epidural analgesia （PCEA） for labor pain. Methods： 300 cases of full- term single- embryony primipara were randomly divided into two groups： The patients of two groups received randomly with ropivacaine （ Group A, n = 150） or bupivacaine （ Group B, n = 150） respectively and PCA pump. We observed analgesia, motor block degree, time of labor course, fetal heart rate, labor mode, Apgar scores and determined pH, PaCO2 , PaO2 level in the blood gas of umbilical artery and vein. Results ： The analgesic efficacy was all satisfactory in the two groups. There were no significant difference in two groups for the pain visual analogue scale （VAS）, the time of progress of labor, Apgar scores, rates of forceps delivery, and cesarean delivery （ P 〉 0. 05 ）. The motor block degree was higher in group A than that in group B, there was significant difference in two groups （ P 〈 0. 05 ）. Conclusion ： Low concentration of ropivacaine used in PCEA for labor analgesia, effective, less motor block compared with low concentration of bupivacaine.