罗哌卡因配伍芬太尼硬膜外镇痛分娩的临床研究

目的　探讨罗哌卡因配伍芬太尼自控硬膜外镇痛分娩的临床效果。方法　选择 5 3例单胎、头位初产妇宫口开大 3cm时采用 0 .2 %罗哌卡因 10 0ml与芬太尼 2 0 0 μg进行自控硬膜外镇痛为镇痛组 ,随机选择同期不愿分娩镇痛的相同条件的 62例初产妇为对照组 ,观察比较两组产妇的产痛程度、产程中使用催产素的情况、活跃期时间、第二产程时间、分娩方式、产后 2h阴道流血量及新生儿Apgar评分。 结果　镇痛组和对照组镇痛总有效率分别为 10 0 .0 0 %和 9.68% ,疼痛记分分别为 0 .74± 0 .5 2分和 2 .2 9± 0 .73分 ,两组比较差异有高度显著性 (P均 <0 .0 0 1)。镇痛组剖宫产率降低 ,但差异无显著性 ;阴道助产率及总的手术产率显著低于对照组 (P <0 .0 5 )。镇痛组和对照组产后 2h阴道流血量分别为 2 2 9.43± 79.48ml和 2 3 5 .65± 69.98ml,新生儿窒息率分别为 3 .77%和 3 .2 3 % ,差异无显著性 (P >0 .0 5 )。结论　罗哌卡因配伍芬太尼进行自控硬膜外镇痛分娩能缩短产程 ,提高自然分娩率 ,不增加产后出血及新生儿窒息率 ,是一种安全、可靠的镇痛方法。

Clinical study on ropivacaine combined with fentanyl for epidural analgesia during labor

Objective To evaluate the efficacy of ropivacaine combined with fentanyl for epidural analgesia during labor.Methods The parturients were randomly divided into an analgesia group and a control group. In the analgesia group (n=53), the primiparae had the signs of monocyesis and fetal head position, and they were given 0.2% ropivacaine 100ml and fentanyl 200μg for epidural analgesia during labor while the dilatation of cervix was 3cm. In the control group (n=62), the primiparae who had the smae signs as the analgesia group were unwilling to undergo analgesia during labor. The comparisons of the labor pain degree, the dose of oxytocin during labor, the active phase, the second stage of labor time, the labor way, the postpartum hemorrhage 2-hour after delivery and the Apgar scores between the analgesia group and the control group had been done. Results The total effective rates of analgesia were 100.00% and 9.68% in the analgesia group and the control group, respectively. The pain scores were 0.74±0.52 and 2.29±0.73, respectively, in comparison of the pain scores between these two groups, the difference was statistically significant, P<0.001. The cesarean decreased slightly in the analgesia group, but there was no statistical significant difference; the vaginal delivery and operation for labor lower markedly than the control group, P<0.05. In the analgesia group and the control group, the colporrhagia volume 2-hour after labor were 229.43±79.48ml and 235.65±69.98ml, respectively, the neonatorum asphyxia rate were 3.77% and 3.23%, respectively, there was no statistically sgnificant difference, P>0.05. Conclusion Ropivacaine combined with fentanyl for patient-controlled epidural analgesia during labor could shorten the stage of labor, increase the natural labor, have the normal postpartum hemorrhage and neonatorum asphyxia, so it is safe and effective for analgesia.