地佐辛复合低浓度罗哌卡因硬膜外自控分娩镇痛在无痛分娩中的应用

目的:观察地佐辛复合低浓度罗哌卡因硬膜外自控分娩镇痛在无痛分娩中应用的效果和安全性。方法:120例初产妇按随机数字表法均分为镇痛组和对照组。镇痛组产妇开放上肢静脉,当产妇宫口开至3 cm时,选择L2³硬膜外间隙穿刺并向头端置管4 cm,注入硬膜外腔1%利多卡因3 ml,观察5 min,如无全脊麻和药物中毒征象,则硬膜外腔注射镇痛液负荷量8 ml,镇痛液配方为0.1%罗哌卡因75 ml复合地佐辛5 mg,给药30 min后连接自控镇痛(PCA)泵,设定持续剂量4 ml/h,负荷剂量2 ml,锁定时间15 min。对照组产妇产程中均未给予任何镇痛措施。观察两组产妇疼痛视觉模拟评分(VAS),产程时间,产后出血量,新生儿1 min、5 minApgar评分,分娩方式,催产素使用情况及不良反应发生情况。结果:镇痛组产妇第一产程、第二产程VAS评分,第一产程时间,剖宫产率均显著低(短)于对照组,自然分娩率、催产素使用率均显著高于对照组,两组比较差异均有统计学意义(P<0.05);第二、第三产程时间,产后出血量,新生儿1 min、5 minApgar评分,不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:地佐辛复合低浓度罗哌卡因硬膜外自控分娩镇痛安全、有效,可有效降低剖宫产率。

Application of Epidural Self-control Labor Analgesia of Dezocine Combined with Ropivacaine in Painless Labor

OBJECTIVE：To observe efficacy and safety of epidural self-control analgesia of dezocine combined with ropivacaine in painless labor. METHODS：120 primiparas were randomly divided into analgesia group and control group. Analgesia group received veins patefaction of upper extremity,and epidural intervertebral space puncture at lumbar spinal segment L2-3 and introduced catheter 4cm when orifice of the uterus opened 3 cm;cavum epidurale injection of 1% lidocaine 3 ml,5 min later,cavum epidurale injection of analgesic liquid 8 ml（0.1% ropivacaine 75 ml＋dezocine 5 mg）if no total spinal anesthesia and drug poisoning was found;30 min later,used patient controlled analgesia pump with maintenance dose of 4 ml/h,loading dose of 2 ml,for15 min. Control group didn＇t received any analgesia therapy during labor. VAS score,duration of labor,postpartum hemorrhage,1and 5 min Appar score,delivery mode,the application of oxytocin and ADR were observed in 2 groups. RESULTS：The VAS scores of first and second stage of labor,the duration of first stage of labor,and the rate of caesarean section in analgesia group were significantly lower than in control group,while the rate of natural labor and the utilization rate of oxytocin were significantly higher than in control group;there was statistical significance（P〈0.05）. The duration of second and third stages of labor,postpartum hemorrhage,neonate 1,5min Apgar score,the incidence of ADR had no statistical significance（P〉0.05）. CONCLUSIONS：The epidural analgesia of dezocine combined with ropivacaine is safe and effective for labor analgesia and can reduce the rate of cesarean delivery.