低浓度与超低浓度罗哌卡因间断硬膜外给药用于分娩镇痛的效果及对产科结局的影响

The effect of low concentration vs. ultra-low concentration of ropivacaine delivered via intermittent epidural boluses for labour analgesia on obstetric and anesthetic outcomes

目的比较在程序化间断硬膜外给药(programmed intermittent epidural bolus,PIEB)复合患者自控硬膜外镇痛(patient-controlled epidural analgesia,PCEA)模式下,低浓度和超低浓度罗哌卡因复合舒芬太尼分娩镇痛的效果及对产科结局的影响。方法选76例ASAⅠ~Ⅱ级、足月单胎头位、无硬膜外麻醉禁忌、要求分娩镇痛的初产妇,随机分为L组(38例):使用0.1%罗哌卡因+舒芬太尼0.5μg/mL;UL组(38例):使用0.06%罗哌卡因+舒芬太尼0.5μg/mL。再配对选择76例未行分娩镇痛的产妇作为C组。两镇痛组产妇宫口开至2~3 cm行硬膜外置管,镇痛平面控制在T8以下,VAS评分控制在4分以下。镇痛开始30 min后连接脉冲式镇痛泵,设置为每隔1 h注射药液8 mL,PCEA6 mL,锁定时间10 min。观察各组产程、分娩方式、新生儿Apgar评分、镇痛效果等。结果 UL组第二产程与C组相比无明显差异,而L组第二产程比C组明显延长(P<0.05)。两镇痛组间疼痛评分及满意度无明显差异,但UL组局麻药用量少于L组(P<0.05)。3组产妇剖宫产率、器械助产率和新生儿评分无明显差异。结论与0.1%罗哌卡因相比,在PIEB+PCEA模式下,0.06%罗哌卡因复合舒芬太尼依然能提供比较满意的镇痛效果,对产科结局的干扰更小,临床上可行。

Objective To compare the effect of low concentration versus ultra-low concentration of ropivacaine in combination with sufentanil delivered via programmed intermittent epidural bolus （PIEB） with patient-controlled epidural analgesia （PCEA） during labour on obstetric and anesthetic outcomes. Methods Seventy-six ASA Ⅰ or Ⅱ nulliparous parturients who were at full term with a singleton fetus in vertex presentation were randomized to receive 0.1% ropivacaine with 0.5 μg/mL sufentanil （Group L, 38 cases） or 0.06% ropivacaine with 0.5 μg/mL sufentanil （Group UL, 38 cases）. Another matched 76 cases of primiparas without labor analgesia （Group C） served as controls. For primiparas received analgesia, an epidural catheter was inserted when the cervical dilatation was up to 2-3 cm. The analgesia level was controlled below T8, and VAS score was controlled below 4. Thirty minutes after analgesia started, Group L and UL received PIEB with PCEA regimen including basal infusion of 8 mL/h of ropivacaine with sufentanil, patient-controlled bolus 6 mL and lockout interval 10 minutes. The duration of labor, delivery mode, Apgar score, VAS score and anesthetic drug consumption of each group were recorded. Results The second stage of labor were not statistically different between Group UL and C. The second stage of Group L was longer than that of Group C （P〈0.05）. Furthermore, with similar performance in pain score and satisfactory level at each time point, Group UL consumed much less ropivacaine than Group L （P〈0.05）. The cesarean section rate, instrumental delivery rate and the Apgar score were not significantly different among the 3 groups. Conclusions While using PIEB with PCEA, 0.06% ropivacaine was capable of providing satisfactory analgesia effects for primipara and has less effects on the obstetric outcome. Therefore, it could be recommended for labour analgesia.