甲磺酸罗哌卡因在产妇硬膜外自控分娩镇痛的临床对照研究

目的：采用甲磺酸罗哌卡因持续硬膜外病人自控（PCEA）法开展分娩镇痛,通过观察其对分娩及围产期母婴的影响,探讨其有效性与安全性。方法：选在我院产检分娩的产妇,选择ASAⅠ级~Ⅱ级,随机分成2组,Ⅰ组0.2%甲磺酸罗哌卡因2μg/ml、8 ml/h;Ⅱ组0.125%布比卡因加2μg/ml芬太尼混合液,4 ml/h。对照组30例,随机选择同期分娩的单胎、头位,无明显头盆不称,临产后不要求药物镇痛的阴道分娩者,在宫口开2~3cm予静脉注射地西盘泮10mg。结果：阻滞后疼痛缓解的情况组内各组两两间比较发现,时点内视觉模拟评分差异无显著性（P〉0.05）,而时点间视觉模拟评分差异有显著性（P〈0.05）。第1产程3组的比较有显著性差异,组间比较显示Ⅱ组较对照组明显延长（P〈0.05）;第2产程Ⅱ组较两组明显延长（P〈0.05）;3组产妇的第3产程无明显差异（P〉0.05）。3组产妇的顺产率与剖宫产率差异无显著性（P〉0.05）,但钳产率差异有显著性,Ⅱ组的钳产率较Ⅰ组和对照组钳产率显著升高（P〈0.05）。Ⅰ、Ⅱ组新生儿脐血pH值和新生儿1 min Apgar评分经统计分析,差异无显著性（P〉0.05）。结论：经硬膜外腔注入甲磺酸罗哌卡因,可获得满意的镇痛效果,同时对宫缩产程和产妇屏气用力及母婴的安全影响不大,是一种安全有效的方法,值得临床推广应用。

Clinical Study on the Effect of Ropivacaine Mesylate on Patient-controlled Epidural Analgesia

Objective： To explore the validity and security by observing the effect of using ropivacaine mesylate for patient-controlled epidural analgesia（PCEA） in labor on delivery and maternal and infant during perinatal period.Method： Labors in our hospital（ASA Ⅰ～Ⅱ） were randomly divided into 2 groups.GroupⅠinjected 0.2% ropivacaine mesylate for 2 μg/ml、8 ml/h,group Ⅱ injected 0.125% bupivacaine and 2μg/ml fentanyl solution.There were 30 labors in control group.Spontaneous delivery women without drug analgesia after delivery whose baby was the single birth,head-position delivery and unobvious cephalopelvic disproportion were randomly chosen to have intravenous diazepam for 10mg during latent phase.Result： A comparison of pain relief after block within group was found out that there was no significantly difference at the point（P0.05） while there were significantly differences between each period（P0.05）.The comparison between 3 groups in the first stage of labor have significantly differences,group Ⅱ was longer than the control group（P0.05）.Group Ⅱ in the second stage was longer than the other two groups（P0.05）.There was no significantly difference of 3 groups in the third stage as well as that was between rate of viginal delivery and cesarean section.The rate of clamp yield of group Ⅱ was significantly higher than groupⅠand the control group（P0.05）.There was no significant difference in cord blood PH and 1min Apgar in group Ⅰand Ⅱ（P0.05）.Conclusion： Epidural ropivacaine methylsulfonate which has little impact on uterine contraction and breath holding during delivery.As a safe and effective method,it is worth to promote and apply.