不同浓度罗哌卡因在硬膜外镇痛分娩中应用效果比较

The clinical analysis of different concentrations of domestic ropivacaine of epidural analgesia in labor

目的 比较不同浓度罗哌卡因在硬膜外镇痛分娩中的应用效果及价值.方法 将300例住院分娩的产妇随机数字表法分为A、B、C三组,其中A组给予0.125％罗哌卡因复合苏芬太尼镇痛,B组给予0.1％罗哌卡因复合苏芬太尼镇痛,C组未要求镇痛分娩,观察三组分娩情况.结果 A组产程用时（261.38±19.87） min,产后2h出血量（241.03±34.57） rmL;B组产程用时（260.09±19.69） min,产后2h出血量（238.66±35.01） mL;C组产程用时（270.46±20.86）min,产后2h出血量（251.75±36.79） mL;组间差异均无统计学意义（t=0.472、1.035,均P＞0.05）.A组胎儿心率（142.34±21.57）次/min,新生儿Apgar评分（9.77±0.21）分,脐动脉血pH值（7.27±0.06）;B组胎儿心率（145.21 ±21.49）次/min,新生儿Apgar评分（9.79±0.20）分,脐动脉血pH值（7.26±0.08）;C组胎儿心率（143.78±22.01）次/min,新生儿Apgar评分（9.64±0.24）分,脐动脉血pH值（7.28±0.07）;组问差异均无统计学意义（t=0.763、0.360、0.114,均P＞0.05）.A组镇痛起效时间（12.13±1.76） min,疼痛评分（1.03±0.46）分,镇痛后宫缩持续时间（22.39±3.21）s,镇痛后宫缩间隔时间（3.26±1.49） min,剖宫产率为8.00％;B组镇痛起效时间（12.04±1.69） min,疼痛评分（1.01±0.52）分,镇痛后宫缩持续时间（21.04±3.18）s,镇痛后宫缩间隔时间（3.49±1.51） min,剖宫产率为9.00％;C组镇痛起效时间（16.77 ±2.51） min,疼痛评分（3.76±1.23）分,镇痛后宫缩持续时间（26.98 ±5.87）s,镇痛后宫缩间隔时间（2.65±0.75） min,剖宫产率为48.00％;组间差异均有统计学意义（x2或t =6.148、8.522、5.749、4.095、61.316,均P＜0.05）.结论 采用0.1％罗哌卡因复合苏芬太尼进行分娩镇痛即能够有效减轻患者疼痛、缩短产程并减少产后2h出血量,同时对宫缩影响小,降低剖宫产率,对新生儿无影响,值得在临床上推广应用.

Objective To compare the effect of different concentrations of ropivacaine in epidural analgesia of childbirth.Methods According to the digital table,300 cases of our hospital childbirth puerpera were randomly divided into A,B,C three groups.A group was given 0.125% ropivacaine compound fentanyl analgesia,B group was given 0.1% ropivacaine compound fentanyl analgesia,group C was not required analgesia childbirth.The childbirth of three groups was observed.Results In group A,the labor time was （261.38 ± 19.87） min,postpartum 2h blood loss was （241.03 ± 34.57） mL.In group B,the labor time was （260.09 ± 19.69） mnin,postpartum 2h blood loss was （238.66 ± 35.01） mL.In group C,the labor time was （270.46 ± 20.86） min,postpartum 2h blood loss was （251.75 ± 36.79） mL.Statistical analysis showed that there was no significant difference （t =0.472,1.035 ; all P 〉 0.05）.In group A,the fetal heart rate was （142.34 ±21.57）times/min,neonatal Apgar score was （9.77 ± 0.21）,and umbilical artery blood pH value was （7.27 ± 0.06）.In group B,fetal heart rate was （145.21 ± 21.49） times/min,neonatal Apgar score was （9.79 ± 0.20）,and umbilical artery blood pH value was （7.26 ± 0.08） ; Fetal heart rate of group C was （143.78 ±22.01）times/min,neonatal Apgar score was （9.64 ±0.24）,and umbilical artery blood pH value was （7.28 ± 0.07）.The differences among three groups were not statistically significant （t =0.763,0.360,0.114,all P〉 0.05）.Analgesic effect time of group A was （12.13 ± 1.76） min,pain score was （1.03 ±0.46） points,analgesic harem duration was （22.39 ± 3.21） s,analgesic harem time interval was （3.26 ± 1.49） min,the cesareandelivery rate was 8.00%.In group B,the analgesic effect time was （12.04 ± 1.69mnin）,pain score was （1.01 ± 0.52） points,analgesic harem duration was （21.04 ± 3.18） s,analgesic harem time interval was （3.4.9 ±1.51）min,the cesarean delivery rate was 9.00% ; Duration of the analgesic effect of group C was （16.77 ±16.77） min,pain score was （3.76 ± 1.23） points,analgesic harem duration was （26.98 ± 5.87） s,analgesic harem time interval was （2.65 ± 0.75） min,the cesarean delivery rate was 48.00%.The differences between groups were statistically significant （chi square or t =6.148,8.522,5.749,4.095,61.316 ;P 〈 0.05）.Conclusion Application of 0.1% ropivacaine compound fentanyl anesthesia can effectively relieve patients＆#39;pain,shorten labor and reduce postpartum 2h blood loss,impact less on contractions at the same time,reduce the incidence of cesarean delivery,has no influence on the neonate,which is worth popularization and application in clinic.