低浓度布比卡因复合芬太尼腰硬联合麻醉在分娩镇痛中的应用

目的：采用小剂量低浓度（0.075%）布比卡因复合芬太尼,应用于腰硬联合麻醉分娩镇痛,探讨该方法的镇痛效果及其对母婴的影响。方法：选择ASAⅠ～Ⅱ级,无椎管内麻醉禁忌证的初产妇500例,本研究共分四组,将自愿接受分娩镇痛的产妇,按镇痛方式随机分为三组,每组125例,Ⅰ组为低浓度腰硬联合镇痛组,Ⅱ组为常规浓度腰硬联合镇痛组,Ⅲ组为硬膜外镇痛组;将其余125例非镇痛产妇,作为对照组,不进行任何镇痛干预。记录镇痛前产妇的基础血压和VAS评分,镇痛给药后2、5、10、15、30、60、120min的血压和VAS评分;观察镇痛起效时间、持续时间、产程时间、分娩方式、胎心率的变化、新生儿Apgar评分及并发症的发生率。结果：Ⅰ、Ⅱ、Ⅲ组镇痛后的VAS评分低于对照组（P〈0.05）;Ⅰ组与Ⅱ组VAS评分,起效时间与持续时间的差异无统计学意义（P〉0.05）,但是Ⅱ组的血压波动大于Ⅰ组（P〈0.05）;Ⅰ、Ⅱ组的起效时间快于Ⅲ组,持续时间长于Ⅲ组（P〈0.05）;Ⅱ组的下肢运动阻滞程度、恶心呕吐的发生率显著高于其他各组。Ⅰ、Ⅱ组的瘙痒发生率高于Ⅲ组及对照组,Ⅰ、Ⅱ组之间差异无统计学意义。结论：小剂量低浓度布比卡因复合芬太尼,应用于腰硬联合阻滞行分娩镇痛,效果确切,对母婴的影响小,且并发症少,可以安全地应用于分娩镇痛。

The application of combined spinal-epidural anesthesia with low concentration of Bupivacaine combined with Fentanyl for labor analgesia

Objective：To observe the application of combined spinal-epidural analgesia with small dose of low concentration（0.075%） Bupivacaine combinded with Fentanyl for labor analgesia and analysis the analgesic effect and its＇ impact on parturients and newborn.Methods：500 cases of primipara,which were ASA class Ⅰ or Ⅱ and without anesthesia contraindication were admitted to the study,they were divided into four groups,the cases which were voluntary to accept labor analgesia,were randomly divided into there groups.Each group had 125 cases.Group Ⅰ：low concentration combined spinal-epidural analgesia;group Ⅱ：conventional-concentration combined spinal-epidural analgesia;group Ⅲ：epidural analgesia;125 primiparas without labor analgesia were chosen as control group.Basic values of arterial blood pressure（BP） of primipara and VAS score were recorded.The blood pressure values and the VAS score were recorded in implementation of anesthetics after 2,5,10,15,30,60 and 120 min respectively;observation was concentrated on analgesia onset time and duration,duration of labor course,mode of delivery,change of fetal heart rate,impact on neonatal Apgar score and incidence of complications.Results：The values of VAS score in group Ⅰ,group Ⅱ and group Ⅲ were significantly lower than those in control group（P0.05）;there was no significant difference between group Ⅰ and group Ⅱ in VAS score,times of onset and duration（P0.05）,but the values of blood pressure fluctuation in group Ⅱ were more obviously than those in group Ⅰ（P0.05）.The onset times in group Ⅰand Ⅱ were faster than that in group Ⅲ.The duration was longer in group Ⅰ and Ⅱ than that in group Ⅲ（P0.05）.The degree of lower limb motor block,the incidence of nausea and vomiting in group Ⅱ were significantly higher than those in other groups.The incidence of pruritus in group Ⅰ and Ⅱ was significantly higher than that in group Ⅲ and control group,but there was no significantly difference in group Ⅰ and Ⅱ.Conclusion：Combined spinal-epidural analgesia with Low concentration of small-dose Bupivacaine combined with Fentanyl can be effectively used in labor analgesia.Its analgesic effect is precise and it has little side-effect on mother and infant,so that it was a safe and effective method for labor analgesia.