低浓度罗哌卡因和左布比卡因用于分娩镇痛对分娩期子宫肌电活动影响的比较

A comparative study between the effects of low concentration ropivacaine and levobupivacaine on uterine myoelectrical activity during labor analgesia

目的比较低浓度罗哌卡因和左布比卡因用于分娩镇痛时对分娩期子宫肌电活动的影响。方法选择自愿要求选择分娩镇痛的100例自然分娩初产妇[0.062 5%罗哌卡因组(罗派组),n=50;0.062 5%左布比卡因组(左布组),n=50],应用体表肌电监测仪收集5个时间段(各30 min),即PeriodⅠ:使用分娩镇痛前;PeriodsⅡ~Ⅳ:分娩镇痛显效后30、60和120 min;PeriodⅤ:第二产程。记录产妇的年龄、体质指数(BMI)、孕周、第一产程时间、第二产程时间、胎儿体重、Apgar评分、产后2 h出血量、视觉疼痛模拟评分(VAS)。采用EMG爆发波能量参数包括爆发波次数/10 min、爆发波持续时间、均方根(RMS)、总功率、功率密度谱的峰值频率评估产妇子宫肌收缩力。结果两组产妇在年龄、孕周、BMI及新生儿分娩结局差异无统计学意义(P>0.05)。左布组产妇的第一产程时长明显长于罗哌组产妇(P<0.05),罗哌组与左布组VAS评分在同一时间点差异无统计学意义(P=0.22)。与罗哌组相比,分娩镇痛显效后30、60 min(PeriodⅡ~Ⅲ)左布组产妇的子宫肌电的爆发波持续时间、爆发波次数/10 min、RMS、功率均显著降低(P<0.001)。在分娩镇痛使用前(PeriodⅠ)和第二产程(PeriodⅤ),组间子宫肌电参数相似。罗哌组产妇的子宫肌EMG能量参数在分娩镇痛使用前后未见明显减弱(P=0.46)。结论 0.062 5%的罗哌卡因用于硬膜外分娩镇痛时能达到与左布比卡因相同的满意镇痛效果,且不影响子宫肌电活动和分娩结局。

Objective To compare the effects between low concentration ropivacaine and levobupivacaine on uterine myoelectrical activity during labor analgesia.Methods A hundred primipara(0.062 5%ropivacaine group,n=50;0.062 5%levobupivacaine group,n=50)who volunteered for labor analgesia were selected.Surface electromyography monitor were applied for recording the uterine myoelectrical activity at 5 time periods:PeriodⅠ,before labor analgesia;PeriodsⅡtoⅣ,30,60 and 120 min after labor analgesia;and PeriodⅤ,the second stage of labor.Maternal age,BMI,gestational week,first stage of labor,second stage of labor,fetal weight,Apgar score,2 h postpartum hemorrhage,and visual analogue pain score(VAS)were recorded.EMG burst energy parameters including burst frequency/10 min,burst duration,root mean square(RMS),total power and peak frequency of power density spectrum were used to evaluate the contractility of uterine muscle.Results There was no significant difference in age,gestational age,BMI or neonatal delivery outcome between the two groups(P>0.05).The duration of the first stage of labor of the mothers using levobupivacaine was significantly longer than that of the mothers using ropivacaine(P=0.001).There was no significant difference in VAS score between the two groups at the same time point(P=0.22).Compared with ropivacaine group,30 and 60 min after delivery analgesia(PeriodⅡ-Ⅲ),the duration,frequency/10 min,RMS and power of EMG in levobupivacaine group were significantly reduced(P<0.001).The EMG parameters were similar between the two groups before and during the second stage of labor(PeriodⅠand PeriodⅤ).EMG energy parameters of uterine muscle in ROPIVA group did not significantly reduced before and after the labor analgesia(P=0.46).Conclusion Ropivacaine for epidural labor analgesia can achieve the same satisfactory analgesic effect as levobupivacaine,and does not affect uterine myoelectrical activity and delivery outcomes.