罗哌卡因复合芬太尼用于可行走式硬膜外分娩镇痛的临床研究

Clinical research of ropivacaine with fentanyl for ambulatory labor extradural analgesia

目的研究应用0.1%罗哌卡因+2μg/mL芬太尼实施可行走式硬膜外分娩镇痛(AEA)的效果,安全性及对母婴和产程的影响。方法择住院初产妇120例,随机分两组各60例,I组为观察组,应用0.1%罗哌卡因+2μg/mL的芬太尼实施AEA,初始量8～12 mL,持续输注率6～10 mL/h锁定15 min给药1次,每次2 mL;II组为对照组。整个产程监测产妇BP、HR、RR、SPO2;观察产妇下肢运动阻滞情况,连续监测宫缩及胎儿心率,记录各产程进展情况及时间;记录新生儿出生后的Apgar评分;按照Mulletr镇痛强度评分法评定产妇的疼痛程度,按照Bromage法评定产妇的下肢运动神经阻滞情况。结果两组产妇的基本生命体征,下肢活动情况,各产程的进展情况,时间,分娩方式及新生儿出生后的Apgar评分无统计学差异(P>0.05)。I组用0.1%罗哌卡因+2μg/mL芬太尼实施AEA后,产妇均感到无痛或仅感到轻度极易耐受的疼痛;II组对照产妇均感到中强度以上疼痛甚至因难以忍受而要求行剖宫产术。结论该方法简便,安全有效,值得在临床上进一步推广。

Objective: To observe the analgesic effect、safety and the stages of labor of ropivacaine with fentanyl for ambulatory labor extradural analgesia(AEA).Methods: 120 primiparous parturients were divided randomly into two groups.The ropivacaine 0.1% plus fentanyl 2μg/mL was used for AEA in groupⅠ,the incipient dose was 8～12mL,the speed of epidural infusion was 6～10mL/h,the addition dose was 2mL per time,and the interval time was locked to 15 minutes.The group II was control group.Maternal blood pressure,heart rate,respiration rate,pulse oxygen saturation,uterine contraction and foetus embryocardia were monitored during labor.he lower limb nervimotor block,the pain degree,the infants' Apgar scores were recorded.The lower limb nervimotor block was observed by bromage scores,the pain degree was evaluated by mulleetr scores.Results: The basic vital sign,degree of nervimotor block,stages of labor and the infants' Apgar were not different,but the rate of good analgesia was significantly higher in group I than that in group II,the incidence of cesarean was significantly higher in group II than that in group I.Conclusion:It is shown that this method is feasible and reliable,and can be well applied in clinical practice.