不同罗哌卡因输注方式用于腰麻-硬膜外阻滞分娩镇痛的比较

Comparison in Various Methods of Infusion of Ropivacaine for Labor Analgesia With Combined Spinal-epidural Anesthesia

目的：探讨不同罗哌卡因输注方式用于腰麻-硬膜外联合阻滞（CSEA）分娩镇痛的效果及对产程和母婴的影响。方法：50例ASAⅠ～Ⅱ级足月单胎初产妇随机分为R1组和R2组,每组25例,两组均在宫口开大至3～4 cm时行CSE操作,蛛网膜下腔注入0.2%罗哌卡因1.5 ml（3 mg）。40 min后：R1组行PCEA镇痛,注入0.1%罗哌卡因与芬太尼2μg/ml混合液,基础输注速率6 ml/h,单次PCA 3 ml,锁定时间10 min。宫口开全时停泵。R2组行硬膜外间断注药镇痛,首次注入0.1%罗哌卡因与芬太尼2μg/ml混合液8 ml,以后在产妇有明显痛感时注入上述药物5 ml,在宫口开大至9 cm时注入最后1次药物。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：两组产妇生命体征平稳,均达到良好的镇痛效果。结论：两组产妇用药后10、30、609、0 min及第二产程、第三产程VAS均〈2分。

Objective： To evaluate the efficacy of various methods of infusion of ropivacaine for labor analgesia with combined spinal - epidural anesthesia（CSEA） and its influence in duration of labor and mother and infant. Methods：50 cases of primipara with full - term and single birth with ASA in grade Ⅰ to Ⅲ were randomly divided into two groups： R1 group（ n = 25） and R2 group（ n = 25）. CASE was administered with injective ropivacaine in dosage of 3 mg when the diameter of uterine orifice was between 3 and 4 cm. After 40 mins, R1 group received PCEA with 0.196 of ropivacaine and 2 μg/ml of fentanyl in rate of infusion of 6 ml/h, PCA in every dosage of 3 ml for 10 mins. The administration ended when uterine orifice fully opened. R2 group received epidural anesthesia with intermit administration, in initial dosage in 8 ml of 0.196 of ropivacaine and 2 μg/ml of fentanyl, then in dosage of 5 ml when showed obvious pain, and with last administration when the diameter of uterine orifice was between 9 cm at last time. The condiation of analgesia and motor nerve blockade was evaluated based on VAS and MBS. The condition, birth process, labor way and Apgar scores of infant was recorded. Results： The vital sign of primiparas in two groups are stable, the two methods of anesthesia are effective in analgesia. Conclusion：The VAS is less than 2 scores at 10, 30, 60 and 90 min after administration, during second and third birth process.