硬膜外麻醉下不同浓度罗哌卡因对分娩镇痛产妇的影响

Epidural Anesthesia with Different Concentration of Ropivacaine on Analgesia Effect of Maternal

目的研究硬膜外麻醉下不同药物浓度的酰胺类局麻药-罗哌卡因(耐乐品)对分娩镇痛产妇的影响。方法随机选择足月初产妇120例为观察对象。运用随机数字表法,将产妇随机分为A组(0.2%罗哌卡因)和B组(0.15%罗哌卡因)均为60例,采用持续硬膜外麻醉。具体麻醉实施方法:(A组),硬膜外穿注入2μg/m L芬太尼+0.2%罗哌卡因混合药液共10 m L;然后PCEA泵入混合药液,以背景量6 m L/h的速度泵注入硬膜外腔。(B组),方法与A组相同,但注入药液为2μg/m L芬太尼+0.15%罗哌卡因混合药液。疼痛程度采用视觉模拟疼痛评分(VAS),记录各组产妇的生命体征、胎心率、产程时间、分娩方式,催产素使用情况及新生儿Apgar评分。结果 1、两组产妇的年龄、身高、体重、孕期无组间差别。2、镇痛效果:镇痛前两组产妇,VAS评分为9~10分;给予镇痛后,A组和B组VAS评分均逐渐降低,两组3 min、5 min、10 min、30 min比较差异显著(P<0.05)。第二产程VAS两组相比无统计学差异(P>0.05)。第三产程两组相比有统计学差异(P<0.05)。3、产程及新生儿Apgar评分:两组比较,无统计学差异(P>0.05)。4、分娩方式及催产素的使用情况:两组分娩方式比较,无统计学差异(P>0.05);剖宫产率及催产素的使用率两组相比无统计学差异(P>0.05)。5、两组临床资料比较,无统计学差异(P>0.05)。6、镇痛起效时间和用药量情况两组相比,有统计学差异(P<0.05)。7、两组产妇不良反应比较,无统计学差异(P>0.05)。结论两组罗哌卡因硬膜外持续输注分娩镇痛不影响产程,不增加剖宫产和阴道助产几率,对母婴均较为安全。B组用药量较A组更少,对产妇子宫收缩力影响更小,有利于顺产。0.15%罗哌卡因辅以小剂量芬太尼(2μg/m L)行自控硬膜外镇痛,镇痛效果确切,而且不影响产程及新生儿,对产妇和胎儿安全有利,是罗哌卡因较为理想的分娩镇痛浓度。

Objective To research under epidural anesthesia with different concentration of amide local anesthetics ropivacaine-（musical works）on the analgesic effect of maternal. Method Randomly selected maternal 120 feet earlier this month as the observation object. Using the random number table, the women were randomly divided into the group A（0.2% ropivacaine）and the group B（0.15%ropivacaine） were 60 cases, using continuous epidural anesthesia. Specific methods of anesthesia：（the group A）, epidural to wear2μg/mL into fentanyl ropivacaine mixed liquid ＋ 0.2% total of 10 mL and PCEA pumped into the mixing liquid, to background 6 mL/h pumping at a rate of epidural injection.（the group B）, and a set of the same, but injection drug 0.15% 2μg/mL ＋ fentanyl ropivacaine mixed liquid. Level of pain by Visual analogue pain score（VAS）, and recorded the Group＇s vital signs and fetal heart rate, duration, mode of delivery, use of oxytocin and neonatal Apgar scores. Results 1, Two groups of age, height, weight, pregnancy were no differences between the groups. 2. Analgesia effect： analgesia before the first two groups, VAS score was 9～10; after analgesia, the group A and the group B, VAS scores were gradually reduced, two groups of 3 min, 5 min, 10 min, 30 min difference were significantly（p0.05）. Second stage of VAS difference between the two groups were not statistically significant（p 0.05）. The third stage of difference between the two groups was statistically significant（P〈0.05）. 3. The birth process and neonatal Apgar score： two groups, with no statistically significant difference（p 0.05）. 4. Mode of delivery and the use of oxytocin： mode of delivery between the two groups, with no statistically significant difference（p 0.05）; Cesarean section rates and oxytocin use compared to the rate between the two groups was not statistically significant（P〉0.05）. 5, the clinical data between the two groups, with no statistically significant difference（P〈0.05）. 6, the analgesic effect of time and dosage of the two groups, there were significant differences（P〉0.05）. 7, maternal side effects between the two groups, with no statistically significant difference（P〉0.05）. Conclusion Two sets of continuous epidural infusion of ropivacaine for epidural labor analgesia without affecting the duration of labor, does not increase the risk of Cesarean section and vaginal delivery to mothers and infants are safer. The group B compared a group of fewer, smaller effect on uterine contractility, conducive to an easy delivery. 0.15% Ropivacaine combined with small dose of fentanyl（2μg/mL）line of patient-controlled epidural analgesia, analgesia, and does not affect the birth process and neonatal, it is safe and benefit for maternal and fetal, it is the ideal analgesic concentration of ropivacaine.