罗哌卡因、芬太尼用于硬膜外分娩镇痛的效果和结局

Efficacy and outcome of epidural infusions of ropivacaine and fentanyl for patient-controlled labor analgesia

目的:评价0.125%的罗哌卡因与每毫升含5μg芬太尼的混合液硬膜外注射用于分娩镇痛的效果与结局。方法:180例初产妇人工破膜后行硬膜外镇痛,先注入1.5%的利多卡因4m l试验剂量后,注入0.125%的罗哌卡因与每毫升含5μg芬太尼的混合液15 m l。再根据病人的要求可给予补充剂量的上述混合液,每次8 m l。另160例初产妇作为对照组未接受镇痛。结果:两组间VAS疼痛分级差异有统计学意义,镇痛组第一产程活跃期明显比对照组,且催产素的使用率高于对照组,差异均有统计学意义。而两组间第二产程、器械助产率和剖宫产率、羊水胎粪污染率、Apgar评分、新生儿体重及产后出血量等差异均无统计学意义。结论:0.125%罗哌卡因与每毫升含5μg芬太尼的混合液硬膜外注射用于病人分娩镇痛具有极好的镇痛效果,不影响母婴结局,不增加器械助产率和剖宫产率。

Objective： To evaluate the efficacy and outcome of 0. 125% ropivacaine with fentanyl 5 μg/ml via epidural for analgesia in labour. Methods： In a study, 180 nulliparous parturients had epidural analgesia after artificial rupture of membrane and was infused with 15 ml solution of 0. 125% ropivacaine and 5μg/ml fentanyl followed by an epidural test dose of 4 ml of 1. 5% lidocaine. Supplementary infusion was provided on patient＇s request with 8 ml of the same analgesic solution each time. Another 160 primigravidas who did not receive epidural analgesia were included in the control group. Results： There were significant differences in the visual analogue pain scores between two groups. The duration of active period in first labor was longer than that in control group and the rate of using oxytocin in analgatic group was higer than that in control group. Both of the two aspects had significant differences. There were no significant differences between two groups in the duration of second labor, in the rate of instrumental delivery and the rate of cesarean section, in the incidence rate of stained aminiotic fluid with meconium, in Apgar scores, birth weight and amount of bleeding. Conclusion： An epidural infusion of 0. 125% ropivacaine with fentanyl 5 μg/ml for labor analgesia provided excellent labour pain relief without adverse effects on maternal and neonatl outcome, and without increased both instrumental delivery rate and cesarean section rate.