不同浓度罗哌卡因在分娩镇痛中的应用研究

目的观察不同浓度盐酸罗哌卡因复合小剂量芬太尼用于硬膜外分娩镇痛的镇痛效果及对母婴的影响。方法将要求自然分娩初产妇60例随机分为三组,每组20例。A组采用0.075%盐酸罗哌卡因,B组采用0.1%盐酸罗哌卡因,C组采用0.15%盐酸罗哌卡因,三组均加1μg/ml芬太尼,均采用连续硬膜外分娩镇痛。观察三组镇痛效果、产程时间、运动神经阻滞情况、最终分娩方式、产后出血情况、剖宫产率及新生儿出生后1min、5minApgar评分以及产妇满意率。结果三组镇痛后疼痛视觉模拟评分(VAS)均显著降低(P<0.01),从VAS绝对值看,25min后B组、C组镇痛效果更佳,但C组运动神经阻滞较B组重,30%(6/20)以上感觉下肢软,轻度乏力,其中运动阻滞发生率为15%;三组产程时间、剖宫产率、产后出血量及新生儿情况比较差异无统计学意义(P>0.05)。B组产妇满意率高于A组、C组(P<0.05或0.01)。结论 0.1%盐酸罗哌卡因加小剂量芬太尼施行硬膜外分娩镇痛,是较合适的镇痛浓度。

Application of different concentrations of ropivacaine in labor Analgesia

Objective To observe the efficacy of different concentrations of ropivacaine combined with small dose of fentanyl on analgesia for women during epidural delivery and its effect on mother and child.Methods 60 mothers who required natural childbirth were randomly divided into three groups,each group with 20 cases.Cases in group A of were treated with 0.075% of ropivacaine hydrochloride,Group B with 0.1% and Group C with 0.15%.Three groups were treated by 1 μg/ml fentanyl and continuous epidural analgesia.The analgesic effects,labor time,motor nerve block,final delivery,postpartum hemorrhage,cesarean section rate and 1 min,5 min Aggar score after birth and maternal satisfaction were all observed for the three groups.Results The VAS scores of each group significantly decreased after analgesia(P<0.01).In terms of the absolute VAS,the analgesia effect of Group B and Group C after 25 mins was better,but the motor nerve block of Group C was heavier,with 30% or more having lower limb soft and amild weakness and with 15% having movement blocking.Labor time,postpartum hemorrhage,Cesarean section rate,newborns’physical conditions of the three groups had no statistically significant differences(P>0.05).Maternal satisfaction rate of Group B is higher than those of the Group A and Group C(P<0.05 or 0.01).Conclusion 0.1% ropivacaine combined with small dose of fentanyl is appropriate concentration for on epidural analgesia.