罗哌卡因复合芬太尼硬膜外注入用于无痛分娩的临床观察

目的：探讨硬膜外置管注入罗哌卡因复合芬太尼用于产妇自控镇痛分娩的效果以及对产程、分娩方式、母婴的影响。方法：选择210例足月初产妇，排除硬膜外置管和阴道分娩禁忌证，完全随机分为镇痛组（130例）和对照组（80例），镇痛组在产程进入活跃期，行硬膜外置管注入0.20％罗哌卡因＋芬太尼混合液进行自控镇痛（PCEA）。注药浓度为6 mL/ h，自控量：3 mL/次，锁定时间为20 min。对照组按产科常规处理。观察记录镇痛效果、运动神经阻滞程度以及产程时间、分娩方式、对母婴的影响等。结果：镇痛组硬膜外置管注药后15~20 min，97.04％的产妇无痛，VAS 评分（0.26±0.027），6.2％的产妇有轻度的运动神经阻滞，45~60 min 后所有产妇均能自如的活动双下肢。镇痛组活跃期时间均短于对照组，第二产程时间明显长于对照组，催产素使用率也高于对照组；第三产程时间、新生儿出生后 Apgar 评分、剖宫产率、助产率均与对照组无明显差异。结论：罗哌卡因复合芬太尼硬膜外置管用于产妇自控分娩镇痛效果确切，对运动神经阻滞较轻：能加快活跃期，但是能延长第二产程，增加催产素使用率；对剖宫产率、助产率无明显影响，不影响新生儿评分。

The clinical observation for application of ropivacaine combined with fentanyl used for pain free delivery via epidural infusion

Objective：To study the effectiveness of the application of Ropivacaine combined with Fentanyl used for PECA, labor stage, delivery mode, women and newborn infants as well in through infusion via epidural catheterization. Methods：210 cases of full term primipara without contraindication of epidural catheterization and vagina delivery have been randomly divided into two corresponding groups： analgesic group （130 cases） and control group （80 cases）. As the analgesic group went into active stage, we took the PECA by infused 0.20%mixed solution of Ropivacaine and Fentanyl with the concentration 6ml/ h, volume 3ml/ each time and determined time 20 minutes via extradural catheterization while the control group was treated routinely. Then, we observed and recorded the analgesic effectiveness, the degree of nerve block, period of labor stage, delivery mode, women and newborn infants, etc. Results： after administration of solution infused via epidural space of the analgesic group, 97.04% primipara were free from pain with VAS scores （0.26±0.027）. 6.2% primipara has a slight motor nerve block. All the primipara could move their lower extremities freely. The active period of the analgesic group was shorter than the control group and the period of the second labor stage obviously longer than that of the control group. The utility of Oxytocin in the analgesic group was higher than that in the control group. There was no difference in the results such as period of the third labor stage, the apgar scores, the rate of cesarean section, the rate of assistant delivery between the two groups. Conclusion： it is confirmed that the effectiveness of the application of Ropivacaine conbined with Fentanyl used for PECA through infusion via epidural catheterization. It has slight motor nerve block and can prompt the active stage but may prolong the second labor stage and increases the use of Oxytocin. It has no influence on the rate of cesarean section, the rate of assistant delivery as well as newborn infant’s apga