小剂量吗啡复合罗哌卡因用于硬膜外分娩镇痛的效果

Efficacy of Low Dose Morphine Combined with Ropivacaine for Epidural Analgesia During Labor

目的探讨罗哌卡因复合小剂量吗啡用于硬膜外分娩镇痛的效果。方法 100例初产妇随机分为观察组和对照组。观察组50例足月初产妇采用0.1%罗哌卡因复合0.1 mg·mL^(-1)吗啡硬膜外分娩镇痛;对照组50例采用0.1%罗哌卡因复合4μg·mL^(-1)芬太尼分娩镇痛。观察镇痛起效时间、作用维持时间、产程时间、分娩结局、血流动力学参数及镇痛效果,记录不良反应,评估新生儿Apgar评分并采集脐动脉血气分析。结果观察组镇痛起效时间长于对照组,作用时间明显长于对照组(P<0.05),2组产妇在镇痛后疼痛数字等级评分(numerical rating scale,NRS)低于镇痛前(P<0.01)。2组产妇产程时间、分娩结局、Bromage评分、新生儿Apgar评分、脐动脉pH值比较均无统计学意义,2组产妇均无严重不良反应。结论罗哌卡因复合小剂量吗啡硬膜外分娩镇痛起效稍慢、作用持久、效果确切、不影响产程、不增加母婴并发症。

OBJECTIVE To investigate the efficacy of low dose morphine combined with ropivacaine for epidural analgesia during labor. METHODS One hundred pregnancy nulliparous parturients were randomly divided into observation group and control group. Pregnancy nulliparous parturients in observation group received 0.1% ropivacaine combined with 0.1 mg·mL^-1 morphine and those in control group received 0.1% ropivacaine combined with 4μg·mL-1 fentanyl for epidural analgesia. The onset time of analgesia, duration of analgesia, labor duration, delivery mode, analgesia efficacy, blood pressure and side effects were recorded. Apgar scores of neonate were assessed and umbilical arterial blood was collected to analysis. RESULTS The onset time of analgesia was longer in observation group than that in the control group, while the duration of analgesia was longer than control group(P<0.05). Numerical rating scale(NRS) was lower than that before analgesia in both groups(P<0.01). There were no significant differences in terms of labor duration, Bromage scores, labor mode, pH of umbilical arterial blood and Apgar score between two groups during labor. No parturients had serious side effects in both groups. CONCLUSION Low dose morphine combined with ropivacaine has slow onset time and long duration of analgesia, and good analgesic effect, but not affect labor duration without increasing side effects during labor.