不同剂量咪唑安定与罗吡卡因用于分娩镇痛的临床观察

Clinical study of different doses of midazolam combined with ropivacaine for delivery analgesia

目的 评价咪唑安定与罗吡卡因用于分娩镇痛的可行性配伍方案。方法 选择产程进入活跃期的单胎初产妇80例 ,随机分为 4组 :Ⅰ组为对照组用药为 1 2 5 g·L-1罗比卡因 10ml;Ⅱ组用药为 1 2 5g·L-1罗吡卡因 10ml含咪唑安定 2 0mg ;Ⅲ组用药为 1 2 5g·L-1罗吡卡因 10ml含咪唑安定 3 0mg ;Ⅳ组用药为 1 2 5 g·L-1罗吡卡因 10ml含咪唑安定 4 0mg ;采用双盲法模拟视觉镇痛评分 (VAS) ,记录用药后BP、HR、SPO2 、RR、不同时段疼痛评分 ,产妇遗忘程度、娩出婴儿Apgar评分及用药后副作用。 结果 用药后 2 4h内不同时段VAS评分在 3～ 15h之间 ,用咪唑安定各组较对照组低 (P <0 0 5 ) ,且随着咪唑安定剂量增大 ,在同一时段内VAS评分依次降低 ,但副作用增多。结论 一定剂量的咪唑安定伍用罗吡卡因用于分娩镇痛较单纯罗吡卡因阻滞完善 ,对产妇和婴儿影响小 ,咪唑安定剂量不宜过大 ,一般小于 4 0mg。

Objective To evaluate feasibility of methods of midazolam combined with ropivacaine for labour pain relief. Methods Eighty parturients, ASA classⅠ～Ⅱ, in active advanced labour were randomly divided into four groups: groupⅠ(control group) 1 25 g·L -1 ropivacaine 10 ml; group Ⅱ 1 25 g·L -1 ropivacaine 10 ml contained midazolam 2 0 mg; group Ⅲ 1 25 g·L -1 ropivacaine 10 ml contained midazolam 3 0 mg; group Ⅳ 1 25 g·L -1 ropivacaine 10 ml contained midazolam 4 0 mg; using a prospective double blind design, visual analog scale (VAS).Recording BP,HR,SPO 2,RR, different time VAS scores,amnesia degree,fetal Apgar scores and side effect after the epidural administrotion. Results Parturients VAS scores of 0～3 h,3～6 h,6～9 h,9～12 h,12～15 h,15～24 h after epidural admimistration, all groups with midazolam decreased markedly as compared with control group( P <0 05), but also with dose increase of midazolam, VAS scores decreased in turn during the same time, however, side reaction increased. Conclusion Certain midazolam combined with ropivacaine blocks better for delivery analgesia as compared with simple ropivacaine, side effect is mild to parturients and fetals. Dose of midazolam is not more than 4 0 mg, otherwise side effect increases.