低浓度罗哌卡因应用于全程硬膜外分娩镇痛对母儿结局的影响

Effect of Low Concentrations of Ropivacaine Applied to Epidural Labor Analgesia on Pregnancy Outcome

目的：探讨低浓度罗哌卡因应用于全程硬膜外分娩镇痛对母儿结局的影响。方法：选取2014年10月-2015年5月在本院妇产科拟行硬膜外分娩镇痛的初产妇140例,按随机数字表法分为A组（n=72）和B组（n=68）,分别给予0.1%和0.125%的罗哌卡因＋0.5μg/m L舒芬太尼进行硬膜外镇痛,另选取同期66例自愿不行分娩镇痛的初产妇作为对照组。比较各组分娩疼痛程度、产程进展及产妇继发性宫缩乏力发生情况、胎心、分娩方式、产后2 h出血量及羊水情况、新生儿窒息发生情况。结果：与对照组产妇比较,A组、B组产妇分娩期间各时段VAS评分均明显降低,第一产程明显缩短,继发性宫缩乏力发生率显著升高,剖宫产率明显降低,差异均有统计学意义（P〈0.05）,A组和B组产妇上述指标的比较差异均无统计学意义（P〉0.05）;三组产妇产后2 h出血量、最低FHR、Ⅱ~Ⅲ度羊水胎粪污染发生率、新生儿窒息率比较,差异均无统计学意义（P〉0.05）。结论：0.1%和0.125%罗哌卡因用于全程硬膜外分娩镇痛均具有较好的镇痛效果,对母婴无不良影响,可广泛应用于分娩镇痛。

Objective： To discuss the effect of low concentrations of Ropivacaine applied to epidural labor analgesia on pregnancy outcome. Method： 140 cases of pregnant women who scheduled for epidural labor analgesia from October 2014 to May 2015 in our hospital were selected and randomly divided into group A （ n=72 ） and group B （ n=68 ）, and were given 0.1% and 0.125% Ropivacaine ＋ 0.5 μ g/mL Sufentanil for epidural analgesia, the other 66 cases pregnant women without labor analgesia were selected as control group. The pain, progress of labor, secondary uterine inertia , fetal heart , delivery mode, 2 h postpartum bleeding, amniotic fluid and neonatal asphyxia were compared between the three groups. Result： Compared with the control group, the VAS scores at each time period of the group A, group B were significantly reduce, the first stage of labor process were significantly shorten, the occurring rate of secondary uterine were significantly shorten increased, the cesarean section rate was significantly decreased （ P〈0.05 ）, and there were no significant differences on the above indexs between the three groups （ P〉0.05 ） . There were no significant differences on fetal heart, 2 h postpartum bleeding, incidence of Ⅱ-Ⅲ meconium stained amniotic fluid and neonatal asphyxia between the three groups （P〉0.05） . Conclusion： 0.1% and 0.125% Ropivacaine applied to epidural labor analgesia has better analgesic effect, and without adverse effects on mother and child, can be widely used in labor analgesia.