极低浓度罗哌卡因复合舒芬太尼在可行走分娩镇痛中的临床研究

Clinical Study on Walking Labor Analgesia with Extremely Low Concentration Ropivacaine Combined with Sufentanil

目的:观察极低浓度罗哌卡因复合舒芬太尼用于产妇可行走腰硬联合麻醉分娩镇痛的临床疗效。方法:选取ASAⅠ~Ⅱ级,单胎头位初产妇510例,依据患者知情自愿原则,随机分为A组、B组、C组三组,均为170例。A组为对照组,采用非分娩镇痛;B组为对照组,采用硬膜外麻醉,使用0.1%罗哌卡因复合舒芬太尼;C组为研究组,采用腰硬联合麻醉,使用0.0625%罗哌卡因复合舒芬太尼。观察、记录产妇镇痛后30 min疼痛评分(VAS)、下肢运动能力评分(Bromage评分)、活跃期时间、第二产程时间、新生儿低Apgar评分发生率、剖宫产率以及使用催产素情况。结果:B组、C组产妇在镇痛后30 min VAS评分显著优于A组;C组产妇在镇痛后30 min VAS评分、Bromage评分表现优于B组;剖宫产率B、C组优于A组;催产素使用率方面B组>C组>A组,差异均有统计学意义(P<0.05),活跃期时间B、C组优于A组(P<0.05),C组又优于B组(P<0.05),在第二产程时间、新生儿低Apgar评分方面三组产妇比较差异无统计学意义(P>0.05)。结论:极低浓度(0.0625%)罗哌卡因复合舒芬太尼用于可行走分娩镇痛具有良好的临床疗效,能有效的减轻产妇的疼痛,从而降低剖宫产率,此外产妇可自由行走,起到加速宫口扩张、缩短产程及降低催产素使用率作用,安全性高,值得临床推广。

Objective： To observe the clinical effect of CSEA walking labor analgesia with extremely low Concentration ropivacaine combined with Sufentanil.nethod： Based on the principles of voluntary and scienter, 510 primiparous women with singleton and cephalic presentation of ASA Ⅰ～Ⅱ were randomly divided into three groups, 170 primiparous women in each group.A group was the control group which was used non analgesia; B group was the control group which was used the epidural ar^esthesia by 0.1% Ropivacaine combined with Sufentanil; C group was the study group which was used epidural anesthesia by 0.0625% Ropivacaine combined with Sufentanil.The pain scores（VAS） after 30 min maternal analgesia, lower limb motor ability score（Bromage evaluation）, the time of second stage of labor, the rate of lower Apgar score, the rate of cesarean and the use of oxytocin situation were observed and recorded.Result： The VAS scores after 30 rain maternal analgesia in B group and C group were significantly better than that in A group, the VAS score after 30 rain maternal analgesia, Bromage score in C group were better than those in the B group, the rate of cesarean in B group and C group were better than that in A group, the rate of oxytocin usage in B group was better than C group, and C group was better than A group（P〈0.05）, the time of active period in B group and C group were better than that in A group（P〈O.05）, C group was better than that in B group（P〈0.05）, the time of second labor, lower neonatal Apgar score in the three groups had no significant differences（P〉0.05）.Conclusion： Extremely low concentrations（0.0625%） Ropivacaine combined with Sufentanil for walking labor analgesia has good clinical effect, can effectively reduce maternal pain, thus reduce the rate of cesarean, in addition women can walk freely to speed uterine cervix dilatation, reduce the stage the labor and the rate of oxytoein usage, they are safe, worthy of promotion.