罗哌卡因与布比卡因用于分娩镇痛的临床研究

Clinical Study of Ropivacaine and Bupivacaine Plus Sufentanyl for Epidural Labor Analgesia

目的对比罗哌卡因和布比卡因自控硬膜外分娩镇痛（PCEA）的效果。方法ASAⅠ～Ⅱ级初产妇足月单胎150例随机分为3组：0．125％罗哌卡因＋舒芬太尼组（R组）、0．125％布比卡因＋舒芬太尼组（B组）和对照组（C组）。采取双盲法进行视觉模拟镇痛评分（VAS）和下肢运动神经阻滞评分（MBS）。记录产程时间、生产方式、胎儿心率（FHR）及新生儿Apgar评分。结果两组产妇分娩镇痛效果良好，差异无统计学意义（P〉0．05）。两组中运动神经阻滞MBS评分，差异有统计学意义（P〈0．05）。与对照组相比，镇痛组第一产程时间缩短，第二产程时间延长，差异有统计学意义（P〈0．05），第三产程时间差异无统计学意义（P〉0．05）。三组新生儿Apgar评分差异无统计学意义（P〉0．05）。结论罗哌卡因分娩作用效果优于布比卡因，能使产妇获得满意的镇痛效果，是一种对母婴安全、不良反应小的镇痛方法。

Objective To compare the analgesic effect and motor block of ropivacaine with bupivacaine plus sufentanyl 2μg/mL in laboring parturient using patient-controlled epidural analgesia（PCEA）. Methods One hundred-fifty ASA Ⅰ～Ⅱ full term primigravidae in active labor who had a single fetus with vertex presentationand were expected to have vaginal delivery were randomly divided into three groups of 50 each： group R received 0.125 % ropivacaine＋sufentanyl, group B received 0.125 % bupivacaine＋sufentanyl and group C received no analgesia of any kind and served as control, using a prospective double- blind design. Basal infusion 6mL/h were supplemented with patient-controlled boluses （2mL/h） every 10 min as required. The parturients evaluated the pain intensity according to visual analog scale （VAS） before epidural placement, 5, 15, 60, 90 and 120min after the epidural administration of 1.5 % lidocaine test dose, respectively. Degree of motor block was measured simultaneously by Modified Bromage Score （MBS）.The labor duration and delivery mode and fetal heart rate （FHR） were recorded. The neonate was assessed using Apgar scores. Results There was no significant difference in VAS scores between both analgesia groups （P 〉 0.05）. Most parturients in both analgesia groups had minimal motor block in laboring and the difference of MBS scores between two groups had statistic significance（P〈 0.05）. Compare with control group, the durations of first stage of labor was decreased and the second stage was increased in both analgesia groups, and the difference among three groups bad statistic significance（P〈0.05）. There was no differences in the incidence of instntmental vaginal delivery and in neonatal Apgar scores and SpO2 among three groups （P 〉 0.05）. Conclusion Ropivacaine is more beneficial and effective than bupivacaine for labor analgesia with PCEA and can provide satisfactory analgesia with negligible side effects during labor and safe both for mother and infant.