罗哌卡因腰麻—硬膜外联合阻滞在分娩镇痛中的应用

Application of ropivacaine for combined spinal-epidural labor analgesia

目的 通过比较布比卡因和罗哌卡因在腰麻—硬膜外联合阻滞 (CSEA)分娩镇痛中的镇痛效果、时效及对产程的影响 ,来探讨罗哌卡因用于CSEA分娩镇痛的可行性。方法 随机选择ASAⅠ～Ⅱ级拟行自然分娩的单胎足月初产妇 10 0例 ,用抽签法分为 2组 ,罗派卡因 (R组 )和布比卡因组 (B组 ) ,均在宫口 (3～ 4 )cm时行CSEA分娩镇痛。腰麻用药R组为 3.75mg罗哌卡因 +2 5 μg芬太尼 ,B组为布比卡因 2 .5mg +2 5 μg芬太尼 ;硬膜外用药R组为 0 .1%罗哌卡因内含 1μg/ml芬太尼 ,B组为 0 .0 6 2 5 %布比卡因内含 1μg/ml芬太尼。观察指标为 :镇痛起效、完善、维持时间 ;运动阻滞程度 ;镇痛强度 ;产妇舒适度 ;产程及分娩方式等。结果 R组镇痛维持时间长于B组 (P <0 .0 5 ) ,镇痛完善时间迟于B组 (P <0 .0 5 ) ,产妇舒适度明显优于B组 (P <0 .0 1)。其余观察指标两组无显著性差异 (P >0 .0 5 )。结论 罗哌卡因可以用腰麻—硬膜外联合阻滞分娩镇痛 。

Objective To access the application of Ropivacaine for combined spinal\|edidural anesthesia in labor analgesia by investigate the influence on labor progress, degree of analgesia and the times of analgesia.Methods 100 healthy nulliparous parturients in spontaneous labor with ASA Ⅰ-Ⅱ, singleton, full\|term fetuses were enrolled and received combined spinal\|epidural labor analgesia then their cervical dilation was in 3～4cm. The patients were randomly assigned in Group B(bupivacaine) and Group R(ropivacaine). The spinal drugs of Group R were 3.75mg ropivacaine +25μg fentanyl and the spinal drugs of Group B were 2.5mg bupivacaine +25μg fentanyl, the epidural drug of Group R is 0.1% ropivacaine include 1μg/ml fentanyl and Group B is 0.0625% bupivacaine include 1μg/ml fentanyl. Data were collected on the time of onset and perfect of analgesia, the degree of motor nerve block, the degree of analgesia, degree of comfort,labor progress and mode of delivery.Results The whole time of analgesia of Group B(\$P\$<0.05), the perfect time of analgesia of Group R is later than Group B(\$P\$<0.05), the degree of comfort of Group R is higher than Group B(\$P\$<0.01).Conclusion Ropivacaine may be applied for combined spinal\|epidural anesthesia in labor analgesia and is superior to bupivacaine.