罗哌卡因复合舒芬太尼硬膜外分娩镇痛对胎方位影响的研究

目的探讨罗哌卡因复合舒芬太尼硬膜外分娩镇痛对胎方位的影响。方法ASAI～Ⅱ级，单胎、足月f≥37周）、枕前位妊娠拟阴道产，自愿要求分娩镇痛的初产妇（400例）为硬膜外分娩镇痛组（B组）。选择同期ASAⅠ～Ⅱ级，单胎、足月（≥37周）、枕前位妊娠拟阴道产，没有选择分娩镇痛的初产妇400例，为对照组（c组）。当产妇宫口开至3em时，开始行分娩镇痛。B组在L2-3。间隙行硬膜外穿刺、置管。硬膜外给予舒芬太尼0．8μg／ml加0．1％罗哌卡因混合液实验剂量5ml，观察5分钟，确认导管位于硬膜外腔后，追加上述混合液5ml。B组30min后以0．1％盐酸罗哌卡因和0．3μg／ml舒芬太尼混合液100ml行患者自控硬膜外镇痛。分娩镇痛组PCA剂量均为6ml，锁定时间均为15min。记录产妇分娩镇痛前、分娩结束时的胎方位。于镇痛前、镇痛5、15、30、60min行视觉模拟评分（VAS），记录分娩方式、产程及缩宫素使用情况。结果与C组相比，B组不会增加胎方位不正的发生率和剖宫产率（14．75％VS11．75％，15．50％vs14．75％，P〉0．051。结论罗哌卡因复合舒芬太尼硬膜外分娩镇痛不会增加胎方位异常的发生率。

The effect of Epidural Analgeisa With Ropivacaine Plus Sufentanil on the Fetal Position Duing Labor

Objective To investigate the effect of epidural analgesia with ropivacaine plus sufentanil on the fetal position during labor. Methods Women were eligible for enrollment if they were ASA Ⅰ - Ⅱ, nulliparous and undergoing a spontaneous labor at term （≥ 37 weeks of gestation ） with a live, singleton fetus in the occiput anterior position. 400 women in active labor （cervical dilatation =3 cm） who requested labor analgesia were in epidural analgesia group （group B）. Other 400 women who did not receive labor analgesia were in the control group （group C）. Women in group B received a test dose of 5 ml of O. 1% ropivacaine with 0.8 μg/ml-1 sufentainl. When correct placement of epidural catheter was confirmed after 5 rains another 5 ml was given. 30 mins after the first dose was given, the epidural cather was connected to the patient controlled epidural analgesia （PCEA） pump. The PCEA solution contained 0. 1% ropivacaine and sufentanil 0.3 μg/ml-1. The PCEA pump was set up with a bolus of 6 ml and lockout interval of 15 rains. The following were recorded：（1）the fetal position before and after delivery; （2） pain intensity was assessed using VAS （0-10）; （3） mode of delivery;（4） labor process; （5） the amount of oxytocin. Results No statistically significant difference was found in the incidence of fetal head malposition and caesarean section in group C and in goup B （14.75 % vs 11.75%, 15.50% vs 14.75%, P 〉 0.05）.Conclusions Epidural analgesia with ropivacaine plus sufentanil did not increase the incidence of fetal head malposition.