产程活跃期患者自控硬膜外分娩镇痛的应用及对母儿结局的影响

Application of Patient-Controlled Epidural Analgesia for Epidural Labor Analgesia and Effects on Mothers and Infants

目的研究产程活跃期患者自控硬膜外分娩镇痛(patient-controlled epidural analgesia,PCEA)的应用效果及对母儿结局的影响。方法对2004年2月至2006年2月要求分娩镇痛的190例单胎、足月临产的初产妇,采用前瞻性研究方法,将其随机分为两组:镇痛组采用0.2%罗哌卡因(98例),镇痛组采用0.1%布比卡因(92例),均辅以芬太尼2μg/ml,首次负荷量为10ml,采用电子镇痛泵调节维持给药量为5ml/h,宫口开全后停用麻醉剂,选取同期未采用任何镇痛方法分娩的100例为对照组(分组征得患者本人的知情同意)。结果镇痛组、镇痛组的孕妇分娩镇痛效果均良好,两组比较,差异无显著意义(P>0.05)。分娩镇痛能缩短产程活跃期时间,降低剖宫产率,与对照组比较,差异有显著意义(P<0.05)。镇痛组与镇痛组相比,使用阴道器械的助产率低(P<0.05),对产妇产后出血无影响(P>0.05),对胎儿和新生儿无不良影响。结论患者自控硬膜外分娩镇痛对母亲及胎儿安全有效,罗哌卡因不影响子宫收缩力和其他产力,更有利于阴道分娩。

Objective To study the analgesic effect and motor block of ropivacaine with bupivacaine in laboring parturient using patient-controlled epidural analgesia（PCEA）. Methods From February 2004 to February 2006, 190 pregnant women were divided into 2 groups randomly. 0.2% ropivacaine was given to group Ⅰ （98 cases） ,and 0.1% bupivacaine was given to group Ⅱ （92 cases）. Fentanyl （2μg/ml）, was added into local anesthetic solution for each group. A loading dose of 10 ml was given. Patient-controlled epidural analgesia was set. The infusion stopped when full uterus was opening. Results Effective labor analgesia provided 2 groups with shortening labor course than the contrast group（P〈0. 05）. Compared with the contrast group, there were significant differences on uterine-incision delivery in group Ⅰ and group Ⅱ （P〈0. 05）. Labor analgesia could shorten labor active course and decline the rate of uterine incision delivery. There was no adverse effect on puerperant postnatal blood loss. The use of oxytocin and instrumental labor in group Ⅰ were less than that of group Ⅱ （P〈0.05）. There was no adverse effect on infants. Conclusion Patient-controlled epidural analgesia is an effective and safe way in labor course. Ropivacaine does not affect uterine contraction and force of labor. Ropivacaine is more profit for vagina delivery.