低浓度罗哌卡因配伍微量芬太尼在产程不同阶段的镇痛效果比较

Comparative Study of Ropivacaine plus Fentanyl for Epidural Labor Analgesia in Latent Phase versus Active Phase of Spontanous Labor

目的观察产妇在产程潜伏期或活跃期联合低浓度罗哌卡因微量芬太尼镇痛对分娩结局的影响,以探讨潜伏期分娩镇痛的安全性。方法采用前瞻性的研究方法,将200例健康、单胎、足月临产初产妇随机分为2组:A组于临产潜伏期内行0.1%罗哌卡因配伍芬太尼(1g/ml)硬膜外阻滞分娩镇痛;B组于临产活跃期内行0.1%罗哌卡因配伍芬太尼(1g/ml)硬膜外阻滞分娩镇痛。记录两组产妇产程时间、分娩方式、新生儿1min和5min Apgar评分、副反应发生率。结果A组第一产程和总产程时间分别为(426±183)min、(488±186)min,B组分别为(397±180)min、(457±179)min,两组比较,差异有统计学意义(<0.05)。A组阴道顺产率、阴道器械助产率和剖宫产率分别为60%(60/100)、19%(19/100)、21%(21/100);B组为53%(53/100)、22%(22/100)、25%(25%),两组比较,差异无统计学意义(>0.05)。A组新生儿1min及5min Apgar评分<7分者分别为11%(11/100)、3%(1/100),B组分别为9%(9/100)、3%(3/100),两组比较,差异均无统计学意义(>0.05)。结论低浓度罗哌卡因配伍微量芬太尼用于潜伏期分娩镇痛延长第一产程,但与活跃期镇痛相比,对分娩方式和新生儿出生结局均无明显影响。

Objective To compare the effects of PCEA combined with ropivacaine in latent versus active phase of labor on the duration of labor and mode of delivery. Methods 200 healthy, full-term, and single-fetus parturient primigravidas in latent phase or active phase of labor who requested epidural analgesia were enrolled in a randomized controlled clinical study. Parturients were randomly allocated to receive epidural 0.1% ropivacaine plus 1 ug/ml fentanyl in latent phase or active phase of labor. The duration of labor, mode of delivery, the neonatal Apgar scores, and the side effects in both two groups were recorded and evaluated. Results Both of the groups were offered reliable analgesia throughout labor. A significant difference was found between the two groups. Group A experienced a significantly longer first stage [（426±83）min] and longer full duration of delivery [（488±86）min] than Group B [（397±80）min], [（457±79） min]. However, there were no significant differences in the second stage of labor, mode of delivery, neonatal Apgar scores, and side effects between the two groups. Conclusion 0.1% ropivacaine plus 1ug/ml fentanyl lengthens the first stage of labor, but it provides a reliable analgesia for patients in the latent phase of labor without significant negative effects on the mode of delivery and the neonates.