低浓度罗哌卡因复合舒芬太尼用于县乡两级医院产妇自控硬膜外分娩镇痛的临床观察

目的：观察罗哌卡因复合舒芬太尼用于县乡两级医院产妇自控硬膜外分娩镇痛的效果。方法：足月单胎头位妊娠初产妇150例，随机分成A组（舒芬太尼），B组（芬太尼），C组（无镇痛），每组50例。A、B两组产妇进入活跃期宫口开至3cm左右时给予分娩镇痛。给药模式：采用负荷量一持续背景量-PCA给药模式。C组为空白对照组，不给予分娩镇痛，按产科常规处理。观察指标：生命体征，镇痛观察采用视觉模拟疼痛评分（VAS），3组测定宫口开至3cm时的VAS为基础值，A、B组PCEA后5rain、15rain、30min、60min及官口开全时和胎儿娩出时VAS；C组予相应时段监测。运动阻滞程度利用改良Bromage评分法评定。记录产程、分娩方式、产后出血及催产素用量；新生儿娩出后1min、5minApgar评分；分娩镇痛的不良反应。结果：镇痛后3组VAS在PCEA15min、30min、60min及宫口开全时差异有统计学意义（P〈0．05），在PCEA5minA、B两组VAS差异有统计学意义。运动功能：A组48例（38％）Bromage评分6分，B组49例（39．2％）Bromage评分6分，余下3例评分5分，不能下床活动，两组差异无统计学意义。3组比较，新生儿娩出后1min、5min的Apgar评分差异无统计学意义。不良反应：组间不良反应发生率差异无统计学意义。结论：低浓度罗哌卡因复合舒芬太尼用于县乡两级医院产妇自控硬膜外分娩镇痛安全可行。

Clinical Observation of Low Concentration Ropivacaine Combined with Sufentanil in Patient-controlled Epidural Analgesia of Maternity in Hospitals of County and Township Levels

Objective： To observe the analgesic effect of low concentration ropivacaine combined with sufentanil in patient-controUed epidural analgesia of maternity in hospitals of county and township levels. Method： One hundred and fifty cases of single cephalic pregnant primipara were randomly divided into group A （ sufentanil ）, B group （ fentanyl ）, group C （ no analgesia ）, each of 50 cases. Delivery analgesia was conducted in primipara of A and B groups when cervix opened to about 3 cm and entered active period. The delivery mode was load-continuous baekground-PCA. Group C was blank control group, conventional treatment was received without giving any anaesthetic. Observation objects were： Vital signs, pain visual analogue scale （ VAS ）, three groups of measured cervix opened to 3 cm VAS based on values, A, B group PCEA after 5 min, 15 rain, 30 min, 60 min and cervix completely opened and fetal disengagement VAS; group C was treated with the corresponding period monitoring. Degree of motor block by using the modified Bromage scoring system. Record the birth process, mode of delivery, postpartum hemorrhage and oxytocin dosage; after delivery, neonatal 1 min, 5 min score of Apgar; adverse reaction of labor analgesia. Result： The three groups in analgesia after PCEA 15 min, 30 min, 60 min and cervix completely opened was provided with a statistically significant difference （ P〈0.05 ） in VAS, and there were statistical differences between A group and B group in VAS after 5 rain （ table ） . Motor function ： 48 cases in group A （ 38% ） Bromage score of 6, 49 cases in group B （ 39.2% ） Bromage score of 6, and the remaining 3 cases scoring 5 points, had not get out of bed, no statistically significant difference between the two groups. The comparison between the three groups, no significant difference in Apgar score of 1 min, 5 min in the neonatal. Adverse reaction ： All of groups the incidence of adverse reaction was no statistically significant. Conclusion： Low concentration ropivacaine combined with sufentanil in patient-controlled epidural analgesia of maternity in hospitals of county and township levels is safe and feasible.