罗哌卡因和布比卡因用于腰-硬联合阻滞分娩镇痛的临床比较

目的比较低浓度的罗哌卡因和布比卡因用于腰麻-硬膜外联合阻滞病人自控(CSEA+PCEA)分娩镇痛的镇痛效果、运动神经阻滞程度及对产程的影响。方法90例单胎足月初产妇随机分为三组,每组30例。A、B组为镇痛组,行CSEA+PCEA分娩镇痛,A组鞘内用0.1%罗哌卡因2.5mg,硬膜外镇痛维持用0.1%罗哌卡因加2μg/ml芬太尼混合液;B组鞘内用0.1%布比卡因2.5mg,硬膜外镇痛维持用0.1%布比卡因加2μg/ml芬太尼混合液;两组产妇均于宫口开大3cm时开始镇痛,宫口开全时停用镇痛药。C组为自然分娩对照组。分别观察产妇生命体征、产程变化、视觉模拟疼痛评分(VAS)、运动阻滞程度评分(改良Bromage评分)和新生儿Apgar评分,记录各组剖宫产率、器械助产率、缩宫素使用率和分娩镇痛的满意度。结果A、B两组产妇均获得良好的镇痛效果,镇痛后A组96.7%产妇能下床行走和自主排尿而B组仅60%,两组比较有显著性差异(p<0.05);镇痛组与对照组比较第二产程有延长,但对分娩方式无影响,各组间的剖宫产率、器械助产率、缩宫素使用率及新生儿Apgar评分均无差异。结论腰-硬联合阻滞病人自控分娩镇痛是一种安全、有效的分娩镇痛方式,而0.1%罗哌卡因复合芬太尼更适用于分娩镇痛。

CLINICAL COMPARISON OF ROPIVACAINE AND BUPIVACAINE USED IN COMBINED SPINAL-EPIDURAL ANALGESIA FOR LABOR

Objective To compare the effect of Ropivacaine and Bupivacaine used in labor combined Spinal -epidural analgesia（CSEA） and its influence on labor course. Methods 90 full term primigravida in active labor who had a single fetus with vertex presentation and were expected to have vaginal delivery were randomly divided into three groups of 30 each： Group A was Ropivacaine group, intrathecal 0.1% Ropivacaine 2.5mg and extradural 0. 1% Ropivacaine plus 21μg/ml Fentanyl ; Group B was Bupivacaine group, intrathecal 0.1% Bupivacaine 2.5mg and extradural 0.1% Bupivacaine plus 21μg/ml Fentanyl ;Group C received no analgesia and served as control. All drugs were stopped at the beginning of second stage. Maternal vital signs （BP, ECG,RR, SpO2）, VAS scores, degree of motor block,pregress of labor,delivery way,usage of oxytocin and Apgar scores were noted. Results Both group A and group B showed good pain relief.. Unassisted walking and spontaneous micturition were observed in 96. 7% parturients of group A but only in 60% parturients of group B. The second stage of delivery were longer in group A and group B than that in group C. There were no significant differences in Apgar scores, delivery way and usage of oxytocin among the three groups. Conclusion Combined Spinal - epidural analgesia was safe and effective. 0.1% Ropivacaine combined with Fentanyl 2 μg/ml is more suitable for analgesia in labor.