不同速率输注0.15%左旋布比卡因硬膜外自控分娩镇痛的临床研究

Clinical study on 0.15% levobupivacaine for patient-controlled epidural analgesia in labour at different infusion speed.

目的研究0．15％左旋布比卡因在不同输注速率下，用于硬膜外自控分娩镇痛的可行性及安全性。方法对80例行自然分娩的单胎足月初产妇，均采用硬膜外自控分娩镇痛，根据不同背景输注速率随机分为四组，A组输注速率为4ml／h，B组为6ml／h，C组为8ml／h，D组为10ml/h。采用视觉模拟评分（VAS）、运动神经阻滞恢复评分（改良Bromage分级）观察镇痛效果；分析产程中母体生命体征及新生儿Apgar、NACS评分，记录0.15％左旋布比卡因的总用量及使用按压给药（bolus）的次数。结果四组患者的年龄、体重及实施镇痛时的宫口大小组间比较无显著性差异（P〉0．05）；母体的生命体征及新生儿Apgar、NACS评分，组间比较亦无统计学意义（P〉0．05）；VAS评分四组均在2．4—2．6之间，无统计学差异；Bromage组间比较无统计学差异（P〉0．05）；A组使用bolus的次数（3．8±0．6）明显高于其它3组（P〈0．01）；D组的器械助产率及低血压等副反应的发生率明显高于其他三组（P〈0．01）。结论研究表明0．15％左旋布比卡因可用于病人硬膜外自控分娩镇痛，且以6～8ml/h的输注速率较为安全可靠。

Objective To study the feasibility and the security of 0. 15% levobupivacaine for patient-controlled epidural analgesia in labour at different infusion speed. Methods Eighty healthy nulliparous parturients scheduled for patient-controlled epidural analgesia in labour, were randomly divided into 4 groups（ n = 20） according to different infusion speed：group t with a speed of 4 ml/h, group II with 6 ml/h, group III with 8 ml/h, group Ⅳ with 10 ml/h. The analgesic effects were assessed by using the visual analog scale （VAS）, modified Bromage score. The following parameters were recorded after pump infusion： blood pressure, heart rate, respiratory rate, oxygen saturation, the adverse events and treatment regiments,the total doses of 0.15% levobupivacaine and the degrees of bolus. Results The general state of health was similar among 4 groups. The VAS score, the Bromage score of mother and the Apgar, NACS score of baby were similar among 4 groups. The degree of bolus in group Ⅰ （ 3.8 ± 0. 6 ） was higher than that in other three groups. The incidence of adverse events was higher（ P 〈 0. 05 ） in group Ⅳ. Conclusion In this study, we demonstrated that 0. 15% levobupivacaine is feasible and safe at 6 - 8ml/h infusion speed for patient-controlled epidural analgesia in labour.