产程潜伏期罗哌卡因硬膜外分娩镇痛的效果

Effects of Epidural Ropivacaine for Labor Analgesia in Latent Phase

目的:观察产程潜伏期罗哌卡因硬膜外分娩镇痛的效果,评价潜伏期镇痛的可行性。方法:初产妇300例,ASAⅠ～Ⅱ级,足月、单胎、头位、无产科并发症及硬膜外麻醉禁忌证,随机分为3组(n=100)。潜伏期组(L组),进入产程后,宫口开至0.5～2.5 cm进行镇痛;活跃期组(A组),宫口≥3 cm进行镇痛;对照组(非镇痛组,C组),不予镇痛药物。L、A组硬膜外穿刺成功后,分次注入0.15%罗哌卡因达10 mL/h,至宫口开全时停止注入药物。行VAS评分和运动神经阻滞分级,记录产程、催产素使用情况、阴道出血量、分娩方式、新生儿Apgar评分及不良反应发生情况。结果:L组和A组镇痛效果、产程、催产素使用及分娩方式构成,差异无统计学意义(P>0.05);但与C组比较,L组、A组镇痛期间呼吸循环平稳,VAS评分降低,产程延长,催产素使用例数增多,顺产及器械助产率增加,剖宫产率降低(P<0.05);三组阴道出血量、新生儿Apgar评分、Bromage分级及不良反应,差异无统计学意义(P>0.05)。结论:产程潜伏期硬膜外腔注入0.15%罗哌卡因行分娩镇痛安全、有效。

Objective： To evaluate the efficacy and safety of epidural analgesia with ropivacaine in nulliparous women presenting in latent phase.Methods： Three hundred ASAⅠorⅡprimiparas,who were at full term with a singleton fetus in vertex presentation without obstetric complications and contraindications to epidural anesthesia,were randomized into 3 groups（n=100 each）,latent group（cervical dilatation 0.5~2.5 cm）,active group（cervical dilatation ≥3 cm） and control group.The epidural analgesia was performed and 0.15% ropivacaine was injected with the dose of 10 mL/h in group L and A,injection was stopped at complete cervical dilatation.Group C is non-analgesia group.The intensity of pain was evaluated using VAS and motor block was assessed using modified Bromage score.The labor process,use of oxytocin,postpartum hemorrhage,mode of delivery,Apgar score of the neonates and the side-effects of analgesia were recorded.Results： There were no significant differences in VAS scores,labor process,use of oxytocin,mode of delivery between group L and A.The VAS scores was lower,labor process was longer,cases using oxytocin was lager,the rates of spontaneous vaginal delivery and instrumental vaginal delivery were higher,and the rate of caesarean section was lower in the two analgesia group than those in the non-analgesia group（P0.05）.There were no significant differences in postpartum hemorrhage,Apgar score of the neonates,Bromage scores and the side-effects of analgesia among the three groups.Conclusion： Epidural analgesia with 0.15 % ropivacaine can be used safely and effectively in latent phase of labor.