腰麻下应用罗哌卡因联合芬太尼在分娩镇痛的疗效观察

Therapeutic effect of ropivacaine-fentanyl spinal anesthesia on labor analgesia

目的探讨蛛网膜下腔麻醉(腰麻)中应用罗哌卡因联合芬太尼在分娩镇痛中的临床疗效。方法选取2015年1月‐2015年12月该院收治的自愿接受镇痛分娩,足月妊娠、单胎头位、无高危妊娠因素且无椎管内麻醉禁忌的产妇200例,随机分为对照组与观察组,各100例。对照组应用芬太尼15μg进行麻醉,观察组应用罗哌卡因2 mg联合芬太尼15μg进行麻醉,对比两组分娩镇痛的疗效。结果两组产妇的血压、心率、呼吸、血氧饱和度(Sp O2)以及胎儿心率差异无统计学意义(P>0.05);观察组分娩后视觉模拟评分法(VAS)评分优于对照组,但差异无统计学意义(P>0.05),镇痛起效时间以及VAS减低至0~2分的时间优于对照组,两组比较差异有统计学意义(P<0.05);两组镇痛后30 min的Bromage评分差异无统计学意义(P>0.05),镇痛后60 min以及宫口全开时的Bromage评分差异有统计学意义(P<0.05);观察组第一产程时间优于对照组(P<0.05),两组第二产程时间差异无统计学意义(P>0.05);观察组顺产率高于对照组(P<0.05);两组新生儿Apgar评分差异无统计学意义(P>0.05);两组分娩期间并发症发生情况差异无统计学意义(P>0.05)。结论腰麻下应用罗哌卡因联合芬太尼在分娩镇痛上的效果显著,安全性高,值得在临床上进一步推广应用。

[Objective] To investigate the clinical efficacy of ropivacaine combined with fentanyl for spinal anesthesia in labor analgesia. [Methods] Two hundred cases of spontaneous analgesic delivery, term pregnancy, single fetal head, no high-riskpregnancy and no spinal anesthesia contraindication were selected from January 2015 to December 2015. The patients were randomly divided into control group and observation group, with 100 cases in each group. The control group was treated with fentanyl 15gg for anesthesia. The observation group was treated with ropivacaine 2rag and fentanyl 15gg for anesthesia, and the effect of analgesia was compared between the two groups. [Results] The blood pressure, heart rate, respiratory rate, blood oxygen saturation level （SpO2） and fetal heart rate between the two groups were not significantly different （P 〉0.05）. The visual analogue scale （VAS） score of the observation group was better than that of the control group （P 〉0.05）, the onset time of analgesia and the time of VAS score decreasing to 0-2 of the observation group was better than those of the control group （P 〈0.05）. There was no significant difference in Bromage score between the two groups at 30 rain after analgesia （P 〉0.05）, but at 60 min after analgesia and when uterine mouth opened entirely, the difference was significant （P 〈0.05）. The time of first stage of labor in the observation group was better than that in the control group （P 〈0.05）, and the time of second stage of labor between the two groups was not significantly different （P 〉0.05）. The rate of eutocia in the observation group was higher than that in the control group （P 〈0.05）. There was no significant difference in Apgar score and the incidence of complications between the two groups （P 〉0.05）. [Conclusion] The application of ropivacaine combined with fentanyl in spinal anesthesia has significant effect on labor analgesia, and it is worthy to be used in clinical practice.