腰-硬联合阻滞在分娩镇痛的应用

Application of combined spinal-epidural analgesia for labor pain relief

目的比较0.15%罗哌卡因和0.075%布比卡因用于腰-硬联合阻滞麻醉(CSEA)下分娩镇痛的临床效果。方法选择1 380例无麻醉禁忌证的初产妇,按产妇意愿对其中660例产妇进行CSEA镇痛分娩:0.15%罗哌卡因组(R组)312例,0.075%布比卡因组(B组)348例,非镇痛对照组(C组)720例,对镇痛效果、神经阻滞程度、产程变化、产后出血量、新生儿体重等项目进行观察。结果R组和B组镇痛效果确切,虽然新生儿体重高于C组,但胎儿窘迫、经阴道助产和剖宫产率三组间差异均无统计学意义,第一、第二产程时间虽然长于C组,但仍在正常范围;R组镇痛后90 minVAS低于B组(P<0.05),其余指标R组与B组差异无统计学意义。结论0.15%罗哌卡因和0.075%布比卡因药效相似,CSEA不增加胎儿窘迫几率,不增加剖宫产率和经阴道助产风险。

Objective To compare the effect of 0.15% ropivacaine and 0. 075% bupivacaine on combined spinal-epidural analgesia （CSEA） for labor pain relief. Methods CSEA with 0.15% ropivacaine was used in 312 parturients （group R） and with 0. 075% bupivacaine in 348 parturients （group B） . Another 720 parturients without CSEA were chosen as the control （group C）. Analgesic effect on mother, the labor course, the mode of delivery, the fetal distress and newbornsr weight were observed and compared. Results Good analgesic effects were obtained in group R and B. The number of fetal distress was decreased significantly in group R and B compared to that in group C. The duration of the first and second labor course was significantly longer in group R and B than that in group C （P〈0.05）. There was no significant difference in the mode of delivery among three groups. Conclusion CSEA with either 0.15% ropivacaine or 0. 075% bupivacaine for labor pain relief is effective, with less rate of fetal distress and no increase in the rate of forceps, vacuum delivery and Cesarean section.