芬太尼和低浓度罗哌卡因应用于腰-硬联合阻滞分娩镇痛的研究

目的观察小剂量芬太尼腰麻后,低浓度罗哌卡因混合芬太尼硬膜外自控镇痛用于缓解分娩疼痛的效果及其对母婴的影响。方法根据随机分组原则,选择自愿分娩镇痛的足月初产妇280例(镇痛组),在宫口开大至2~4 cm时,选择右侧卧位下取L 2~3间隙行腰硬穿刺。硬膜外穿刺成功后,通过穿刺针置入25 G腰穿针行腰穿,见有脑脊液流出时注入芬太尼20μg,向硬膜外腔置入硬膜外导管3~5 cm并固定。通过硬膜外导管连接PCA泵行PCEA方式镇痛,输注0.15%罗哌卡因和1.5μg/mL的芬太尼混合液。此外,随机抽取同期自然分娩的不做镇痛的足月初产妇280例作为对照组。观察两组的镇痛效果、运动能力、产程时间、新生儿Apgar评分、分娩方式和生命体征。结果镇痛组的镇痛效果确切而且生命体征平稳。两组运动能力影响比较无显著性差异(P>0.05)。与对照组比较,镇痛组活跃期时间缩短(P<0.05),剖宫产率降低(P<0.01);两组借助器械分娩率和新生儿Apgar评分比较无显著性差异(P>0.05)。结论小剂量芬太尼和低浓度0.15%罗哌卡因用于腰-硬联合阻滞分娩镇痛安全、有效、可行,且无明显副作用。

Study on effect of ropivacacine and fentanyl on combined spinal epidural anesthesia analgesia for delivery

Objective To observe the efficacy and influence of patient-controlled epidural analgesia using ropivacacine combined with fentanyl for delivery.Methods 560 primiparas who chose delivery analgesia were randomized into two groups:PCEA Group(n=280) received 0.15% Ropivacacine and 1.5 μg/mL Fentanyl by PCEA.Analgesia was not used for the control group(n=280).The analgesic effect,motorability,labor periods,Apgar score of newborns,delivery mode and vital signs were recorded.Results The analgesic effect of PCA group was exact,and the vital signs was stable.Compared to control group,the active stage was shorter(P<0.05),and the incidence of C-section was lower(P<0.01) in group PCEA.There was no significant difference in motorability,incidence of instrumental labor,and Apgar score of newborns(P>0.05) between the two groups.Conclusion Mall-dose Ropivacacine combined with Fentanyl are safe and effective for CSEA delivery analgesia,and have no obvious side effect.