罗比卡因用于腰-硬联合阻滞分娩镇痛对产程和新生儿的影响

Effect of Ropivacaine on Labor Course and Neonates During Labor Analgesia with Combined Spinal-epidural Analgesia

目的：探讨罗比卡因用于腰麻-硬膜外联合阻滞（CSEA）分娩镇痛对产程和母婴的影响。方法：随机选择20例ASAⅠ-Ⅱ级足月单胎初产妇行分娩镇痛作为观察组,另选择20例条件相近但不给分娩镇痛的产妇为对照组。观察组在宫口开大至3～4 cm时行CSE操作,蛛网膜下腔注入0.2%罗比卡因1.5 ml（3 mg）。在腰麻后40 min行PCEA镇痛,注入0.1%罗比卡因与芬太尼2μg/ml混合液,基础输注速率6ml/h,单次PCA 3 ml,锁定时间10 min。宫口开全时停泵。用视觉模拟评分（VAS）和下肢运动神经阻滞评分（MBS）评估镇痛情况和下肢运动神经阻滞情况,观察并记录产妇生命体征、产程时间、生产方式及新生儿Apgar评分。结果：观察组产妇生命体征平稳,均达到良好的镇痛效果。两组产妇活跃期时间存在差异有统计学意义（P〈0.01）。第二产程、第三产程时间、生产方式及新生儿出生后1、5、10 min的Apgar评分两组比较无统计学差异（P〉0.05）。结论：罗比卡因用于CSEA分娩镇痛时可取得良好的镇痛效果,对运动神经阻滞轻且不影响产程和母婴。

Objcetive： To evaluate the effect of ropivacaine on the labor course and neonates during the labor analgesia with combined spinal - epidural analgesia（CSEA） . Methods： 20 ASA Ⅰ - Ⅱ full - term primigravidaes were selected in study group and 20ASA Ⅰ - Ⅱ full - term primigravidaes were no analgesia as the cotnrol group. The combined spinal - epidural（CSE） technique were administered in the study group When the external cervical os was dilated to 3--4 cm lumbar puncture was performed at L2-3 or L3-4 with a special CSE needle, A dose of 0.2 % ropivacaine 1.5 ml（3 mg） was injected into the subarachnoid space, then epidural catheter was advanced cephalad for 3--4 cm. When subarachnoid block was wearing off（about 40 rain） ： The patients received PCEA with 0.1% ropivacaine and fentanyl 2 μg/ml, basal infusion 6 ml/h, PCA bolus 3 ml, lockout time 10 min. Drug was stopped at beginning of the second stage （cervical dilatation 10 cm）. Level of pain（VAS visual analogue scores）, degree of motor block （MBS modified Bromage scores）, duration of labor , mode of delivery and neonatal Apgar＇ scores was observed. Results ： A good and safety effect of labor analgesia were received in study group. The active stage of study group experienced a significantly shorter than the control group（P 〈 0.01）, The second stage of study group was longer than the control group（P 〈 0.05）, There was no different in duration of labor, mode of delivery and neonatal Apgar＇ score （P 〉0.05）. Conclusion ：Ropivacaine was used during labor analgesia with combined spinal - epidural technique provided satisfactory and effective analgesia It was less influence on motoneuron and no influence on both labor course and neonates.