布比卡因与罗哌卡因硬膜外自控分娩镇痛临床效果及其对新生儿脐血管血气分析指标的影响比较

Comparison of Bupivacaine and Ropivacaine for Epidural Labor Analgesia and Influence on Blood Gas Indexes of Neonatal Umbilical Vessel

目的:探讨布比卡因与罗哌卡因硬膜外自控分娩镇痛临床效果差异及对新生儿脐血管血气分析指标的影响。方法:选取我院产科2012年1月至2013年12月硬膜外自控分娩镇痛的产妇150例,以随机数字表法分为A组(75例)和B组(75例),分别给予布比卡因+芬太尼或罗哌卡因+芬太尼复合麻醉镇痛,比较两组镇痛前后视觉模拟评分法(VAS)、第一和第二产程时间、宫缩持续时间、胎儿娩出后产妇改良Bromage评分、新生儿娩出后5 min Apgar评分及脐血管血气分析指标。结果:A组患者镇痛前、镇痛后5 min、10 min、15 min及20 min VAS评分分别为(9.33±2.93)分、(4.56±1.18)分、(3.21±0.95)分、(2.63±0.77)分、(1.17±0.45)分;B组患者镇痛前、镇痛后5 min、10 min、15 min及20 min VAS评分分别为(9.40±2.98)分、(4.50±1.14)分、(3.17±0.93)分、(2.57±0.74)分、(1.12±0.43)分;两组产妇镇痛后VAS疼痛评分均显著优于镇痛前,差异有统计学意义(P<0.05);两组产妇镇痛后不同时间点VAS疼痛评分组间比较差异无统计学意义(P>0.05)。A组产妇第一、二产程时间及宫缩持续时间分别为(413.25±50.82)min、(52.66±15.90)min、(0.37±0.12)min;B组产妇第一、二产程时间及宫缩持续时间分别为(406.89±49.98)min、(50.81±15.73)min、(0.34±0.11)min;两组产妇第一、第二产程时间及宫缩持续时间比较差异无统计学意义(P>0.05)。两组胎儿娩出后产妇改良Bromage评分和新生儿娩出后5 min Apgar评分比较差异无统计学意义(P>0.05)。两组胎儿娩出后脐动脉和脐静脉血气分析指标组内比较差异无统计学意义(P>0.05),组间比较差异有统计学意义(P<0.05),但均在正常范围内。结论:布比卡因与罗哌卡因均可有效用于硬膜外自控分娩镇痛,且对新生儿脐血管血气分析指标无明显影响。

Objective： To investigate differences of bupivacaine and ropivacaine for epidural labor analgesia and influence on blood gas indexes of neonatal umbilical vessel. Methods： One hundred and fifty lying-in women with epidural labor analgesia from January 2012 to December 2013 in obstetrics department in our hospital were chosen and randomly divided into two groups including group A （75 cases） with bupivacaine combined with fentanyl and group B （75 cases） with ropivacaine combined with fentanyl. The VAS scores before and after analgesia, labor time of first stage and second stage, cervix contraction duration time, maternal modified Bromage score, Apgar score in 5 min after delivery and blood gas indexes of umbilical vessel after delivery of both groups were compared. Results： The VAS scores before analgesia, in 5 rain, 10 rain , 15 rain and 20 rain after analgesia of group A were separately （ 9.33±2.93 ） points, （4.56±1.18 ） points, （3.21±0.95 ） points, （2.63±0.77 ） points, （ 1.17±0.45 ） points, the VAS scores before analgesia, in 5 min, 10 min ,15 min and 20 min after analgesia of group B were separately （9.40±2.98） points, （4.50±1.14） points, （3.17±0. 93） points, （2.57 ±0.74） points, （1.12±0.43） points. The VAS scores after analgesia of both groups were significant better than before analgesia （ P〈0.05 ）, there was no significant difference in VAS scores after analgesia between two groups （ P〉0. 05 ）. The labor time of first stage and second stage, cervix contraction duration time of group A were separately （413.25±50.82） min, （52.66±15.90） min, （0.37±0. 12） min. The labor time of first stage and second stage, cervix contraction duration time of group B were separately （406.89±49.98） min, （50.81±15.73） min, （0.34±0.11） min. There were no significant differences in labor time of first stage and second stage, cervix contraction duration time between two groups （ P〉0.05 ）. There were no significant differences in maternal modified Bromage score and Apgar score in 5 min after delivery between two groups （ P〉O. 05 ）. There were no significant differences in blood gas indexes of umbilical vessel after delivery, before and after analgesia （ P〉0.05 ）, but there was significant difference between two groups （ P〈0.05 ）. Conclusion： Bupivacaine and ropivacaine for epidural labor analgesia possess perfect effects and have no influence on blood gas indexes of umbilical vessel.