罗哌卡因复合芬太尼腰-硬联合阻滞用于第一产程潜伏期分娩镇痛的临床观察

目的观察罗哌卡因复合芬太尼腰硬联合麻醉用于第一产程潜伏期分娩的安全性。方法选择足月初产妇60例,ASAⅠ～Ⅱ级,孕龄38～40周,产前检查在正常范围,既往无心肺疾病病史。随机分为镇痛组(30例)和对照组(30例)。镇痛组于潜伏期,宫口<3 cm时行分娩镇痛(罗哌卡因复合芬太尼腰-硬联合麻醉);对照组于活跃期,宫口≥3 cm时,行分娩镇痛。观察在开始镇痛前即刻、镇痛后5、10、30 min产妇的生命体征及胎心率。分别记录开始镇痛前即刻、镇痛后5、10、30 min、宫口开全等时点的疼痛程度、产程时间、分娩方式、缩宫素用量、新生儿Apgar评分及不良反应等指标。结果在产程期间两组产妇的生命体征及胎心率基本平稳,指标变化比较差异无统计学意义(P>0.05);镇痛后各时点的组间比较差异无统计学意义(P>0.05);两组产妇第一、二产程时间、分娩方式、缩宫素用量及不良反应比较差异无统计学意义(P>0.05)。两组新生儿出生后1min、5 min Apgar评分比较差异无统计学意义(P>0.05)。结论 0.1%罗哌卡因复合芬太尼腰-硬联合阻滞用于第一产程潜伏期分娩镇痛,与活跃期镇痛组相比,获得相当的镇痛效果,分娩过程相似,产妇循环稳定,无明显并发症,新生儿评分无明显差异。

Clinical observation of ropivacaine and fentanyl spinal-epidural in the incubation period of the first stage of labor anesthesia for labor analgesia

Objective To investigate the safety of ropivacaine combined with fentanyl spinal epidural anesthesia for the incubation period of the first stage of labor to delivery.Methods 60 cases of primipara with no history of cardiopulmonary disease(ASA Ⅰ~Ⅱ)were chose,the gestation age was 68~40 weeks,prenatal care was in the normal range.The patients were randomly divided into analgesia group(n=30)and control group(n=30).Analgesia group was given analgesia(lumbar epidural anesthesia of ropivacaine combined with fentanyl)in the incubation period with cervix<3 cm;control group was given analgesia in the active phase with cervix≥3 cm.The vital sign and fetal heart rate was observed immediately before analgesia and 5,10,30 min after analgesia,and the indicators observed at the same time were as follows:VAS scores at different cervix congruent points,labor duration,mode of delivery,oxytocin use,neonates Apgar score and adverse reactions,et al.Results The maternal vital signs and fetal heart rate of the two groups were stable respectively(P>0.05),and no significant difference in the change of them between the two groups was observed(P>0.05).There was no significant difference in the time of first and second stage of labor to delivery,mode of delivery,dosage of oxytocin,1 min and 5 min Apgar scores of neonates and adverse reaction between the two groups(P>0.05).Conclusion 0.1% ropivacaine combined with fentanyl spinal-epidural block for the incubation period of the first stage of labor analgesia has equivalent analgesic effect with similar delivery process and neonatal scores compared with the active period of analgesia group,the maternal circulation is stable without obvious complication.