不同浓度罗哌卡因用于可行走性硬膜外分娩镇痛的临床研究

目的比较不同浓度罗哌卡因复合芬太尼持续输注在可行走性分娩镇痛中产妇BP、HR、SpO2、产程、胎心、宫缩的变化及缩宫素使用率及对视觉模拟评分（VAS）及产妇运动神经阻滞的影响。方法选择自愿要求行分娩镇痛的初产妇180例，采用不同浓度罗哌卡因行PCEA，并与同时未行镇痛的产妇进行比较，随机分为A、B、C组各60例，三组产妇经硬膜外腔分别注入0．075％罗哌卡因＋芬太尼2．0μg／ml、0．125％罗哌卡因＋芬太尼2．0μg／ml、0．20％罗哌卡因＋芬太尼2．0μg／ml，于宫口开至2-3cm时，L2-3硬膜外穿刺向头端置管，注0．8％利多卡因，5min后给负荷量8—10ml镇痛液，确定镇痛平面，疼痛明显减轻后接镇痛泵。持续输注药液6～8ml，单次按压量3ml，间隔时间15min，宫口开全停药。结果三组产妇可行走性分娩镇痛后各时间点VAS评分均显著降低，差异有统计学意义（P〈0．05）；实施可行走性分娩镇痛后A、B组运动神经阻滞，在0级、1级、2级出现的例数与C组比较差异有统计学意义（P〈0．05），再追加局麻复合液三组比较差异无统计学意义（P〉0．05）；三组产妇分娩方式及缩宫素使用情况及新生儿Apgar评分比较差异无统计学意义（P〉0．05）。结论0．125％罗哌卡因＋芬太尼2．0μg／ml持续输注用于可行走性分娩镇痛时镇痛效果好，运动神经阻滞轻，值得临床推广。

Objective To compare the different concentrations of ropivacaine combined with fentanyl infusion analgesia labor in walking labor analgesia in maternal BP,HR,SpO2,labor,fetal heart,uterine contractions and oxytocin usage and the visual analogue scale (VAS) and maternal motor nerve block.Methods 180 cases of primipara volunteered for labor analgesia,ropivacaine with different concentration of patient controlled epidural analgesia (PCEA),and compared with parturients without analgesia,were randomly divided into group A,group B and group C with 60 cases in each group,three groups were respectively injected into the epidural 0.075％ ropivacaine and fentanyl 2 μ g/ml (group A,n=60),0.125％ ropivacaine plus fentanyl 2 μ g/ml (group B,n=60),0.20％ ropivacaine and fentanyl 2 μ g/ml (group C,n=60).With the cervix opening to the 2-3 cm,L2-3 epidural cephalad catheter,injection of 0.8％ lidocaine,5 mins to the load of 8-10 resistant analgesic liquid,confirming the analgesic plane,pain significantly reduced with analgesia pump.Continuous infusion of 6-8 ml,a single push volume of 3 ml,interval time of 15 min,wide open withdrawal.Results The results of three groups of maternal analgesia labor walk at each time point after VAS score was significantly lower with significant difference (P ＜ 0.05); feasible implementation of labor analgesia in group A,group B motor nerve block,in class 0,grade 1,2 cases of group C,and the difference was statistically significant (P ＜ 0.05);additional anesthesia compound liquid of three groups had no significant difference (P ＞ 0.05); there was no significant difference between three groups of maternal mode of delivery and use of oxytocin and neonatal Apgar score (P ＞ 0.05).Conclusion 0.125％ ropivacaine + fentanyl was 2 μg/ml continuous infusion for labor analgesia when walk good analgesic effect,motor nerve block light,is worth the clinical promotion.