复合芬太尼与罗哌卡因用于临产分娩镇痛的对照研究

[目的]探讨芬太尼与罗哌卡因自控镇痛用于分娩镇痛的对照研究。[方法]采用回顾性分析的方法,选择200例健康、单胎、足月临产初产妇,观察组(100例)采用0.1%罗哌卡因 芬太尼(1μg/mL)硬膜外腔给药用于分娩镇痛,对照组(100例)未实施任何镇痛措施。观察两组产妇的镇痛效果、产程时间、分娩方式、新生儿Αpgar评分及产后24h出血量。[结果]镇痛有效率为96.0%;两组产妇在产程中血压、脉搏、呼吸的变化差异无统计学意义(P>0.05);产程时间比较:第一产程和总产程差异有统计学意义(P<0.05),第二产程、第三产程差异无统计学意义(P>0.05);分娩方式及缩宫素使用情况比较:观察组缩宫素使用明显多于对照组,差异有统计学意义(P<0.05);剖宫产率比较差异有统计学意义(P<0.05);新生儿Αpgar评分及产后24h出血量两组比较差异均无统计学意义(P>0.05)。[结论]低浓度的罗哌卡因复合芬太尼用于分娩镇痛对产妇第一产程及总产程有缩短作用,降低剖宫产率,自控镇痛,同时增加了缩宫素使用率,但对新生儿出生结局无明显影响。     

不同浓度罗哌卡因复合芬太尼用于分娩镇痛的临床研究

目的比较不同浓度罗哌卡因复合小剂量芬太尼用于分娩镇痛的效果。方法100例单胎、足月、头住初产妇，ASAⅠ～Ⅱ级，随机分成四组，每组n=25。所用药物：A组：0．075％罗哌卡因；B组：0、125％罗哌卡因；C组：0．2％罗哌卡因，每组均加21ag／ml芬太尼：D组：对照组，未行分娩镇痛，于产程进展宫口开3cm时，行硬膜外腔穿刺置管，首次剂量硬膜外腔给予8—12ml，半小时后，连接PCA泵持续硬膜外腔输注，维持量6～10ml／h至宫口开全停药，PCA剂量4ml，锁定时间30min。所有产妇均行视觉模拟评分WAS）和改良Bromage评分，评估镇痛、运动神经阻滞情况，观察记录各组产妇的生命体征、产程时间、分娩方式及新生儿Apgar评分。结果A、B、C组与D组相比产妇用药后VAS评分均明显降低。且A、B、C组第一产程均较对照组明显缩短（P〈0．01），但A组的镇痛效果欠佳，VAS评分高于B、C组，有显著差异（P〈0．01）。C组的难产率较高，与对照组相比有显著差异（P〈0。01）。B组镇痛效果最满意。宫口扩张速度和胎头下降速度较快，分娩中产妇的BP、HR、RR平稳，对产程和分娩方式及新生儿Agpar评分均无明显影响，联合用药可减少局麻药用量。结论0.125％罗哌卡因复合芬太尼用于硬膜外分娩镇痛（PCEA）对产程影响最小，镇痛效果确切，简便易行。是硬膜外分娩镇痛较为理想的药物浓度。     

罗哌卡因复合芬太尼用于分娩镇痛的临床观察

目的：观察0.2％罗哌卡因 2μg/ml芬太尼用于分娩镇痛的效果。方法：从待产的初产妇95例中选择自愿要求分娩镇痛的30例产妇为观察对象。将0.2％罗哌卡因 2μg/ml芬太尼用于分娩镇痛，观察其对母婴的影响及镇痛效果。结果：0.2％罗哌卡因 2μg/ml芬太尼用于分娩镇痛可产生良好的镇痛效应，不影响母亲，不影响新生儿的呼吸，产妇与家属满意度高。结论：0.2％罗哌卡因 2μg/ml芬太尼用于分娩镇痛是一种较理想的分娩镇痛方法。     

罗哌卡因复合芬太尼硬膜外分娩镇痛120例分析

目的：评价罗哌卡因复合芬太尼硬膜外分娩镇痛的效果及安全性。方法：选择无阴道分娩禁忌证自愿要求镇痛分娩的初产妇120例作为观察组，未要求镇痛分娩的186例作为对照组，比较两组产妇的镇痛效果、分娩结局、产程时间、催产素的使用率、产后出血量及新生儿结局。结果：观察组镇痛效果明显，活跃期短。顺产率高（P〈0．01），而催产素使用率、器械助产率、产后出血量、新生儿结局两组无显著差异（P〉0．05）。结论：罗哌卡因复合芬太尼硬膜外分娩镇痛效果确切，降低了剖宫产率，缩短了产程，新生儿结局好，是一种安全有效的分娩镇痛方法。     

罗哌卡因联合芬太尼硬膜外自控镇痛用于分娩镇痛疗效分析

目的:探讨罗哌卡因联合芬太尼硬膜外自控镇痛用于分娩镇痛的临床疗效。方法:选取2015年11月至2017年11月在本站就诊的62例产妇,随机分为观察组(罗哌卡因+芬太尼硬膜外自控镇痛,n=31)和对照组(未接受分娩镇痛,n=31)。对比两组临床疗效。结果:镇痛前两组VAS评分比较,差异无统计学意义(P>0.05)。宫口开6cm、10cm时,观察组VAS评分显著低于对照组(P <0.05)。观察组第一产程和剖宫产率均显著少于对照组(P <0.05),但催产素使用率显著高于对照组(P <0.05)。两组第二产程和Apgar评分比较,差异无统计学意义(P>0.05)。结论:罗哌卡因联合芬太尼硬膜外自控镇痛用于分娩镇痛疗效显著。     

罗哌卡因复合芬太尼分娩镇痛的临床观察

目的：观察低浓度罗哌卡因复合芬太尼应用于分娩镇痛的有效性和安全性。方法：选择足月妊娠、头位、单胎、无明显头盆不称,无椎管内硬膜穿刺禁忌且自愿要求分娩镇痛的初产妇60例为观察组,以同期的头位、单胎、无明显头盆不称的初产妇60例作对照组,产程中不用镇痛药。观察两组产妇的镇痛效果（VAS评分）、下肢运动神经阻滞MBS（modified bromage score）产程进展、分娩方式、新生儿Apgar评分、产后出血量。结果：镇痛组产妇镇痛有效率100%,下肢运动神经阻滞轻,宫口扩张速度快、活跃期缩短、剖宫产率低,与对照组比较差异有显著性（P〈0.05）;两组第二、三产程、器械助产率、产后出血量、新生儿Apgar评分均无统计学差异。结论：采用低浓度罗哌卡因复合芬太尼用于分娩镇痛安全、有效,是理想的分娩镇痛方法。     

罗哌卡因或布比卡因复合芬太尼分娩镇痛的临床研究

目的:对比罗哌卡因与布比卡因用于硬膜外分娩镇痛的效果。方法:60例单胎初产妇随机分为0.l％罗哌卡因-芬太尼组和0.1％布比卡因-芬太尼组。采用双盲法进行视觉模拟镇痛评分（VAS）和下肢运动神经阻滞评分（MBS）。记录产程时间、生产方式、感觉阻滞平面、新生儿A评分。结果:两组产妇分娩镇痛良好,负荷量5分钟后,罗哌卡因组镇痛效果明显优于布比卡因组（P<0.01）,此后两者镇痛效果相近。罗哌卡因组的平面上升速度比布比卡因组快。罗哌卡因对运动神经的影响明显弱于布比卡因（P<0.01）,布比卡因组的器械助产率达23％。结论:罗哌卡因复合芬太尼分娩镇痛优于布比卡因。     

低浓度罗哌卡因复合芬太尼用于可走式分娩镇痛的临床观察

目的：观察0．1%罗哌卡因＋芬太尼2ug／ml硬膜外阻滞用于可行走分娩镇痛的安全性和可行性。方法：分镇痛组（A组）和对照组（B组）各30例，ASAI级，单胎头位，足月妊娠，初产妇，宫口开大2-3cm时，A组产妇于L2-3，椎间隙行硬膜外穿刺向头端置管，平卧位后。注入实验量0．852；利多卡因5ml，5min后测试镇痛平面并确认未误入蛛网膜下腔或血管后再注入0．852；的利多卡因6～8ml，15～20分钟疼痛明显减轻后，接电脑微量镇痛泵，药液配制为0．152；，罗哌卡因＋芬太尼2ug／ml共75ml，维持输液量为6．0-7．0ml／h单次按压量3ml，锁定时间为15分钟，观察产妇、生命体征，疼痛程度，运动能力，分娩情况，以及新生儿情况。结果：A组镇痛效果确切和B组比较有显著差异，而运动能力、分娩情况、新生儿评分与普通分娩无明显差异。结论：0．1%罗哌卡因复合芬太尼2ug／ml用于可行走式分娩镇痛效果确切，对母胎无不良影响，用于临床安全而有效。     

罗哌卡因复合芬太尼用于可行走式硬膜外分娩镇痛探讨

目的：探讨可行走式硬膜外分娩镇痛。0．1％罗哌卡因复合2．0μg／mL芬太尼用于产妇自控硬膜外镇痛的效果及对产程、母婴的影响方法：选择150例ASAⅠ-Ⅱ级的单胎足月初产妇行分娩镇痛为观察组：另选150例条件相仿但不给予分娩镇痛者为对照组。观察组穿刺成功平卧后注入0．8％利多卡因4mL,5min后经硬膜外导管给予0．1％的罗哌卡因加芬太尼2．0μg／mL，行硬膜外病人自控镇痛。其负荷量6mL。背景输入量以6-8mL／h的速度控制持续给药，病人自控镇痛剂量2．0mL，锁定时间10min。用视觉摸拟评分（VAS）和下肢运动神经阻滞评分（MBS）评估镇痛、阻滞效果。观察记录产妇的生命体征、产程时间、生产方式及新生儿Apgar评分。结果：观察组产妇生命体征平稳，用药后10min 99．1％的产妇感到无痛[VAS评分为（0．6±0．8）分]，仅0．9％的产妇镇痛不全。与镇痛前比较，观察组产妇用药后有5例下肢感到麻木，但下肢活动不受限制，MBS评分为1分，其余产妇用药后下肢感觉无异常，MBS评分为0分，MBS评分前后无统计学差异（P〉0．05）。观察组活跃期时间为（98．48±52．87）min，短于对照组（135．86±71．05）min （P〈0．01）。观察组第二产程时间为（50．83±24．81）min，比对照组（48．46±21．82）min稍长（P〉0．05）。观察组新生儿出生后1、5min Apgar评分，生产方式与对照组比较无统计学差异。结论：0．1％的罗哌卡因加芬太尼2．0μg／mL用于可行走式的硬膜外分娩镇痛安全有效。不影响产程及新生儿，可以达到可行走式分娩镇痛。     

低浓度罗哌卡因复合芬太尼用于硬膜外分娩镇痛

分娩痛是产妇中普遍存在的难以忍受的剧痛，给产妇带来很大的身心痛苦，有的产妇因惧怕自然分娩，从而使剖宫产率升高。随着医学的发展及人们生活水平的显著改善，减轻和消除分娩疼痛，已成为麻醉科和产科工作者共同关注的问题。本院运用低浓度罗哌卡因复合芬太尼硬膜外阻滞用于分娩镇痛取得了一定的疗效，现报告如下。     

罗哌卡因用于分娩镇痛的效果观察

分娩是一种生理过程,随着医学模式的转变和人们生活质量的提高,产妇对分娩也提出了更高的要求,为减轻母亲在分娩过程中的痛苦,我院采用罗哌卡因硬膜外分娩镇痛,取得了较好的临床效果"现报道如下.     

Mode of delivery following labor epidural analgesia: influence of ropivacaine and bupivacaine.

Epidural analgesia is a popular and effective method for pain relief during labor. Bupivacaine is a commonly used local anesthetic for labor epidural analgesia. Ropivacaine is an amino acid local anesthetic that is structurally related to bupivacaine with a similar potency and duration, but ropivacaine has less cardiac toxicity than bupivacaine and produces less motor blockade. These properties make ropivacaine a desirable local anesthetic agent for obstetrical analgesia. The purpose of the present study was to compare the cesarean section and instrumental delivery rates for patients receiving labor epidural analgesia using bupivacaine and ropivacaine. The medical records of 500 consecutive patients receiving bupivacaine for labor epidural analgesia were reviewed. After a 3-month familiarization period for ropivacaine, the records of 500 consecutive patients receiving ropivacaine for labor epidural analgesia similarly were reviewed. The groups did not differ demographically. The instrumental delivery rate was 14.2% for the bupivacaine group and 9.8% for the ropivacaine group. The cesarean section rate was 14% for the bupivacaine group and 10.2% for the ropivacaine group. At our facility, the use of ropivacaine decreased both cesarean section and instrumental delivery rates when compared with bupivacaine in the population studied.     

Levobupivacaine and ropivacaine: the new choices for labor analgesia

For several decades, bupivacaine has enjoyed great clinical popularity as the first choice local anaesthetic for pain control in labour. However, introduction of ropivacaine and most recently levobupivacaine, the two newer and presumably safer (thought to be less cardio- and neurotoxic than bupivacaine) local anaesthetics, has challenged the position of bupivacaine as a gold standard to labour analgesia. Most pregnant patients receive their initial information regarding labour analgesia from primary care providers including family physicians, midwives, and obstetricians. This review article, intended for primary care providers, briefly addresses the current controversies regarding choice of local anaesthetics for pain management in labour.     

非药物性分娩镇痛的研究进展

对国内外非药性分娩镇痛的方法及其安全性进行综述,以期进一步完善不足之处.     

Neonatal monitoring after maternal fentanyl analgesia in labor

Objective. To characterize different methods of monitoring neonatal effects associated with maternal opioid analgesia. Special focus was on the static-charge-sensitive bed (SCSB), which could potentially serve as a non-invasive neonatal monitor. Methods. 12 healthy, term newborns from normal pregnancies were included in this prospective, randomized, controlled study. Maternal labor analgesia was either intravenous fentanyl (n= 5) or paracervical bupivacaine blockade (n= 7). Neonatal recording from delivery to the age of 12 hours included continuous SCSB monitoring with ECG and oximeter for sleep states, respiration, oxygenation, heart rate, and body movements. In addition, umbilical blood pH, Apgar, Amiel-Tison's Neurologic and Adaptive Capacity Scoring (NACS), skin cyanosis scoring, blood pressure, rectal and skin temperatures, and skin blood flow measurements were performed. Results. The study was interrupted, because one baby in the fentanyl group had a significant decrease in oxyhemoglobin saturation (SpO₂) to 59%. This was considered to be residual effect of fentanyl and was treated with naloxone. SpO₂ was generally lower in the fentanyl group. Epochs with SpO₂ < 90% were more frequent in the fentanyl group, especially during active sleep (mean ± SD11.9 ± 10.7% vs. 2.0 ± 1.7% of epochs, p= 0.034). Mean heart rate values were lower in the fentanyl group (121.1 ± 6.4 vs. 132.6 ± 6.8 beats per minute, p= 0.02), and this difference was seen during wake and all sleep states. Maximum heart rate values were lower in the fentanyl group, too. The opiate group had less quiet sleep than controls (9.6 ±2.8% vs. 18.3 ± 8.3%, p = 0.05). NACS after birth was lower in the fentanyl group (median [range] 15[13–26] vs. 22 [20–25], p= 0.004). Conclusions. Several differences were seen between the fentanyl and the control group babies. The SCSB method proved sensitive enough to find neonatal effects of maternal analgesia. Together with ECG and SpO₂ monitoring, SCSB gives plentiful information on neonatal well-being in anon-invasive way. Results of this study emphasize the importance of neonatal monitoring after maternal opiate use in labor. This revised version was published online in July 2006 with corrections to the Cover Date.     

罗哌卡因复合舒芬太尼硬膜外自控镇痛用于分娩镇痛的效果分析

目的探讨罗哌卡因复合舒芬太尼硬膜外自控镇痛用于分娩镇痛的临床效果及对母婴结局的影响。方法选择温县人民医院2012年1月至2014年1月收治的行分娩镇痛的足月初产妇132例,按照患者自愿原则分为对照组64例与治疗组68例。对照组不给予镇痛药物,治疗组给予硬膜外腔注入盐酸罗哌卡因与舒芬太尼混合液。观察两组的镇痛效果、第一产程时间、第二产程时间、新生儿1min、5min时的Apart评分、缩宫素使用率。结果给药前治疗组与对照组VAS评分比较差异未见统计学意义(P0.05)。给药30min后及第一产程、第二产程VAS评分变化比较差异有统计学意义(P0.05)。两组第一产程时间、第二产程时间、新生儿1min、5minApart评分、缩宫素使用率比较差异无统计学意义(P0.05)。结论罗哌卡因复合舒芬太尼硬膜外自控镇痛用于分娩镇痛能有效减轻产妇疼痛,对母婴结局无不良反应,安全性好。     

影响产妇运用分娩呼吸方法依从性的因素研究

[目的]了解初产妇运用分娩呼吸方法的依从性并分析其影响因素。[方法]采用问卷调查法对102例初产妇进行调查,了解初产妇运用分娩呼吸方法依从性情况,并筛选出影响运用呼吸方法依从性的因素。[结果]102例初产妇中依从者70例（68.6%）,不依从者32例（31.4%）; 单因素分析显示,不同文化程度、居住地、视觉模拟评分（VAS）、通过孕期学校了解分娩运用呼吸方法的知识、助产士讲解到位程度、陪产者或助产士持续支持和对自然分娩自信的初产妇依从性不同（P〈0.05或P〈0.01）; Logistic回归分析显示,文化程度、低疼痛评分值、助产士讲解到位、陪产者或助产士持续支持为影响运用呼吸方法依从性的保护因素。[结论]根据影响产妇运用呼吸方法依从性的因素,采取针对性的护理措施,可提高分娩运用呼吸方法的依从率,从而促进产程进展和自然分娩。     

A comparison of motor block between ropivacaine and bupivacaine for continuous labor epidural analgesia.

The aim of the present study was to compare the amount of motor block produced by different loading doses of ropivacaine and bupivacaine when delivered in a dilute solution with added opioid. Sixty-eight healthy term primigravid parturients were randomized to receive an initial bolus dose of 10 mL of 1 of the following: 0.25% bupivacaine (high bupivacaine), 0.25% ropivacaine (high ropivacaine), 0.125% bupivacaine (low bupivacaine), or 0.125% ropivacaine (low ropivacaine). Each loading dose had 10 micrograms of sufentanil added to it. All groups received a continuous infusion of a 0.1% study drug infusion with 0.6 microgram/mL of sufentanil at a rate of 8 to 14 mL/h to maintain analgesia. Supplemental doses of 10 mL of a 0.125% study solution with 10 micrograms of sufentanil were given as needed. Pain scores and a modified Bromage scale were used to assess analgesia and motor block. A statistically significant greater percentage of parturients receiving bupivacaine had motor block than those who received ropivacaine, with a marked decrease in the occurrence of motor block in the low ropivacaine group. The pain relief seemed to be less satisfactory in the ropivacaine groups, but the difference was not statistically significant. Ropivacaine produced significantly less motor block than bupivacaine in the 0.25% and the 0.125% loading doses, with the greatest difference seen in the lower concentration loading dose of ropivacaine.