左旋布比卡因或罗哌卡因复合舒芬太尼用于硬膜外分娩镇痛的效果

Efficacy of epidural PCA with levobupivacaine or ropivacaine combined with sufentanil for labor analgesia

目的探讨硬膜外左旋布比卡因或罗哌卡因复合舒芬太尼用于分娩镇痛的效果。方法初产妇60例随机均分L组、R组，实施硬膜外分娩镇痛。镇痛药液总量生理盐水100ml，其中，L组为0．1％左旋布比卡因＋0．5μg／ml舒芬太尼，R组为0．1％罗哌卡因＋0．5μg／ml舒芬太尼。患者自控镇痛（PCA）参数：负荷量10ml，背景维持量6ml／h，PCA单次剂量5ml，锁定时间15min。记录镇痛期的VAS疼痛评分和相关指标。结果两组分娩期镇痛效果均满意；但宫口开大3～10cm的过程中，L组VAS疼痛评分均低于R组（P〈0．05）。两组产程、催产素使用率、分娩方式、新生儿Apgar评分以及不良反应情况差异均无统计学意义（P〉0．05）。结论硬膜外左旋布比卡因或罗哌卡因复合舒芬太尼用于分娩镇痛均能获得良好的镇痛效果。前者的镇痛效果更好。

Objective To investigate the efficacy of epidural patient-controlled analgesia（PCA） with levobupivacaine or ropivacaine combined with sufentanil for labor analgesia. Methods Sixty uniparas were randomly assigned into two groups of L and R with 30 cases each. The epidural PCA labor analgesia was performed with 0.1 G levobupivaeaine plus 0.5 μg/ml sufentanil in group L or 0. 1% ropivacaine plus 0. 5 μg/ml sufentanil（group R） in normal saline 100 mk After a loading dose of 10 ml was given, the PCA variables were set up as background infusion 6 ml/h, demand dose 5 ml with a lockout interval of 15 min. VAS pain score was evaluated at the times of cervical dilation of 3,5,8 and 10 cm. The indicators related to delivery and analgesia were compared between two groups. Results A satisfactory labor analgesia was obtained in both groups. The VAS pain scores during the process of cervical dilation were lower in group L than those in group R（P〈0.05）. There were no significant differences in the labor course, oxytocin usage, mode of delivery, Apgar scores and umbilical artery blood gas analysis of newborns, and adverse effects between two groups. Conclusion Epidural PCA with levobupivacaine or ropivacaine combined with sufentanil can provide a satisfactory analgesia for labor. The former has better analgesic effect than the latter.