罗哌卡因复合曲马多或芬太尼硬膜外分娩镇痛的比较

A comparison of patient-controlled epidural analgesia with ropivacaine combined with tramadol or fentanyl for labor analgesia

目的比较罗哌卡因复合曲马多或芬太尼硬膜外麻醉用于分娩镇痛的效果。方法 36例初产妇随机均分为0.125%罗哌卡因+曲马多5mg/ml(T)组和0.125%罗哌卡因+芬太尼2μg/ml(F)组。比较两组镇痛效果、分娩资料、新生儿脐动脉血气分析及Apgar评分。结果 T组产妇在镇痛后10、15min视觉模拟评分高于F组(P<0.05)。两组产妇Bromage评分、产程时间、催产素使用、分娩方式差异均无统计学意义。T组产妇无不良反应;F组3例产妇出现不良反应。T组新生儿脐动脉血pH值高于F组,PCO2低于F组(P<0.05);两组新生儿Apgar评分差异无统计学意义。结论罗哌卡因复合曲马多硬膜外分娩镇痛效果好,产妇和新生儿不良反应少,但镇痛起效稍慢。

Objective To compare the efficacy of patient-controlled epidural analgesia（PCEA） with ropivacaine combined with tramadol or fentanyl for labor analgesia.Methods Forty pregnancy nulliparous parturients undergoing PCEA were equally randomized to receive 0.125% ropivacaine with tramadol 5 mg/ml（group T） or with 2 μg/ml fentanyl （group F）.The analgesia efficacy,labor data,umbilical artery blood gas analysis and Apgar scores were observed.Results Visual analog scale was higher in group T than that in group F at 10 min and 15 min during PCEA（P〈0.05）.There were no significant differences in Bromage scores,labor duration,oxytocin consumption,labor mode and Apgar score between two groups during PCEA.No parturient had side effects in group T,while 3 parturients suffered from side effects in group F.Umbilical arterial pH was higher,while PCO2 was lower,in group T than those in group F（P〈0.05）.Conclusion PCEA with ropivacaine combined with tramadol is better than that with fentanyl for labor analgesia with less side effects despite a slightly later onset of analgesia.