氯普鲁卡因缓解分娩镇痛中爆发痛的效果

Efficacy of chloroprocaine for relieving breakthrough pain during labor analgesia

目的评价氯普鲁卡因缓解分娩镇痛中爆发痛的临床效果。方法选择拟行硬膜外分娩镇痛且第一产程出现爆发痛的初产妇60例,年龄20~36岁,BMI 21~35 kg/m^(2),ASAⅠ或Ⅱ级,随机分为两组:对照组和观察组,每组30例。在出现爆发痛(VAS疼痛评分≥4分)时,对照组硬膜外注入0.15%罗哌卡因6 ml,观察组硬膜外注入1.5%氯普鲁卡因6 ml。给药后每2分钟评估一次VAS疼痛评分,记录给药后VAS疼痛评分降至3分的时间及追加药次数。记录产程时间、产时出血量、缩宫素使用例数、分娩方式以及不良反应的发生情况、产妇满意度评分。记录新生儿出生后1、5 min的Apgar评分,并检测脐动脉血气。结果与对照组比较,观察组硬膜外加药后VAS疼痛评分降至3分的时间明显缩短,产妇满意度评分明显增高(P<0.05)。两组追加药次数、产程时间、产时出血量、缩宫素使用率、分娩方式、不良反应发生率以及新生儿Apgar评分和脐动脉血气分析差异无统计学意义。结论罗哌卡因与氯普鲁卡因均可有效缓解爆发痛,氯普鲁卡因起效更快,产妇满意度更高。

Objective To evaluate the efficacy of chloroprocaine for relieving breakthrough pain during labor analgesia.Methods Sixty primiparas,aged 20-36 years,BMI 21-35 kg/m^(2),ASA physical statusⅠorⅡ,requesting epidural analgesia and experiencing breakthrough pain during the first stage of labor were enrolled and randomly assigned into two groups:control group(n=30)and observation group(n=30).A rescue dose was added with 0.15%ropivacaine or 1.5%chloroprocaine 6 ml via epidural route in the control group or the observation group for breakthrough pain(VAS score≥4),respectively.The time when VAS scores decreased to 3 pionts and the dosing frequency were recorded in both groups.Meanwhile,the maternal satisfaction score with analgesia,Apgar scores of newborns and umbilical artery blood gas analysis were measured and recorded.Results Compared with the control group,the time of VAS scores decreasing to 3 pionts after rescue dose was significantly shortened,and the maternal satisfaction score was significantly increased in the observation group(P<0.05).There were no statistically significant differences between the two groups in the dosing frequency,duration of labor phrase,intrapartum hemorrhage,utilization rate of oxytocin,delivery mode,adverse reactions,Apgar scores of newborns,and umbilical artery blood gas analysis.Conclusion Both ropivacaine and chloroprocaine can effectively relieve breakthrough pain during labor analgesia,but the onset time of chloroprocaine is faster and maternal satisfaction is higher.