罗哌卡因在分娩镇痛中的应用

目的：观察不同浓度罗哌卡因（ropivacaine,Rop)用于分娩镇痛的临床效果，探索其理想的浓度和剂量。方法：随机选择ASAⅠ-Ⅱ级临产初产妇45例，平均分为三组：0．16％Rop组和0．2%Rop组作为观察组，以及对照组15例。观察组于宫口开至2－3cm时于L2－3间隙行硬膜外腔穿刺置管，以罗哌卡因维持镇痛；对照组未作分娩镇痛。围分娩镇痛期地监测血压（BP）、脉氧饱和度（SpO2)、EKG、PETCO2、宫缩及胎心音，记录产程时间：镇痛效果采用VAPS评分法进行疼痛评分，运动神经阻滞以Bromage分级评分；新生儿出生后1－5min进行Apgar评分，分娩后24h新生儿NACS评分。结果：围分娩期三组生命体征稳定；VAPS评分观察组较对照组明显降低，但0．2％Rop对运动神经的阻滞频率和程度最重，对宫缩有轻微的抑制，催产素用量相对增加；对产的影响均短于对照组，但差异不显著，三组对围分娩期胎心、Apgar评分无影响；分娩后24hNACS评分观察组较对照组增高明显；剖宫产率0．16％、Rop组最低。结论：罗哌卡因独特的感觉和运动阻滞明显分离，对子宫胎盘血流无明显影响，有利于分娩镇痛。0．2％Rop较0．16％对运动神经阻滞的频率和程度更重0．16％Rop对分娩镇痛是一种比较理想的局部麻醉药。

Application of Ropivacaine in Analgesia of Labor Application of Ropivacaine in Analgesia of Labor Application of Ropivacaine in Analgesia of Labor

To observed the Clinical effect of ropivacaine (Rop) of different concentration used for analgesia of labor, and ex plore the ideal concentration and dosage. Methods: 45 case s of ASA Ⅰ-Ⅱ primiparae nearing labor were vandomly divided three groups rand omly (0.16% Rop group, 0.2% Rop group were assigned 15 cases). The analgesia, in which the cervical os had opened up to 2-3cm; the controlled group was not giv en the analgesia of labor. BP, SpO2, EKG, PETCO2, cerrical contraction , fetal cardiac sounds were monitored continuously in the perinatal analgesia pe riod. The analgesia effects were determined by giving a mark for pain by VAPS, motor nerve blockings were given amark by Bromage scale; Apgar scale were conduc ted 1-5 min after neonates were labored out. Results: The vital signs of three groups were stable in perinatal; the VAPS scale was lower s ignificantly in observed group than in controlled group; while the blocking freq uency and extent of motor nerve were highest from 0.2% Rop, which had light inhi bitory effect to cervical contraction, causing the dosage of oxytocin to increas e relatively; the NACS scale 24 h after labor was more increased significantly in observed group than controlled group. Conclusion: The un ique blockings to sense and motor were obviously separate, having no obvious eff ect to blood stream of uterus and placenta, being benificial to analgesia in per inatal. The 0.16% Rop was a more ideal local anaesthesia agent than 0.2% Rop .