不同浓度罗哌卡因规律间断硬膜外给药分娩镇痛对产间发热的影响

目的比较不同浓度罗哌卡因规律间断硬膜外给药分娩镇痛对产间发热的影响。方法选择拟行硬膜外分娩镇痛的初产妇100例,年龄20~35岁,单胎头位,随机分为0.1%罗哌卡因+0.4μg/ml舒芬太尼组(H组)和0.08%罗哌卡因+0.4μg/ml舒芬太尼组(L组),每组50例。两组均以每60分钟硬膜外腔注入8 ml上述不同混合药液的方式实施硬膜外镇痛。观察镇痛前、镇痛后1、2、3、4、5 h、分娩即刻和分娩后1 h的鼓膜体温、VAS疼痛评分、改良Bromage评分,并记录麻醉药物用量、产程及新生儿1、5 min的Apgar评分。结果与镇痛前比较,两组产妇镇痛后4、5 h、分娩即刻和分娩后1 h的鼓膜体温明显升高(P0.05);H组在镇痛后4、5 h的体温明显高于L组(P0.05)。两组产间发热率差异无统计学意义。与镇痛前比较,镇痛后1、2、3、4、5 h、分娩即刻和分娩后1 h两组产妇VAS评分均明显降低(P0.05),但组间差异无统计学意义。结论 0.08%罗哌卡因或0.1%罗哌卡因复合0.4μg/ml舒芬太尼规律间断硬膜外给药行分娩镇痛效果满意,而用较低浓度局麻药产妇在分娩镇痛期间体温的上升幅度较小。

Clinical study of regular intermittent bolus of different concentrations of ropivacaine for epidural labor analgesia on maternal inpartum fever

Objective To compare the influence of regular intermittent bolus of different con-centrations of ropivacaine for epidural labor analgesia on maternal intrapartum fever.Methods One hundred parturients aged from 20 to 35 years,of ASA Ⅰ or Ⅱ,singleton pregnancy,head presenta-tion,were randomly divided into two groups:Group H with 0.1% ropivacaine and 0.4 μg/ml sufen-tanil,Group L with 0.08% ropivacaine and 0.4 μg/ml sufentanil,50 cases in each group.Both groups were given epidural analgesic solution of 8 ml every 60 minutes respectively.Maternal tympanic membrane temperature,pain visual analogue scale (VAS),and modified Bromage score were recorded at the beginning of analgesia,1,2,3,4,5 h post analgesia,delivery,and 1 h post de-livery.And the anesthetics consumptions,labor duration,and neonatal Apgar score of 1,and 5 min were also observed.Results Compared with the beginning of analgesia,maternal tympanic membrane temperature significantly rose at 4,5 h post analgesia,delivery,and 1 h post delivery in both groups (P <0.05).Compared with group L,maternal tympanic membrane temperature significantly rose at 4,and 5 h post analgesia in group H (P <0.05).There was no significant difference in the incidence of intrapartum fever between the two groups.Compared with the beginning of analgesia,maternal VAS significantly decreased from 1 h post analgesia to 1 h post delivery in both groups (P <0.05);but there was no statistically significant difference between the two groups.Conclusion Regular inter-mittent epidural bolus of 0.08% or 0.1% ropivacaine combined with 0.4 μg/ml sufentanil can provide satisfactory labor analgesia,and body temperature rises more dramatically in women receiving higher concentration of local anesthetic than those receiving lower concentration.