不同浓度罗哌卡因复合舒芬太尼在硬膜外阶梯式分娩镇痛中的应用

目的观察不同浓度罗哌卡因复合舒芬太尼硬膜外阻滞在产程潜伏期阶梯式分娩镇痛中的效果。方法选择2015年2~4月单胎头位初产妇210例,随机分为七组,每组30例。1组:0.125%罗哌卡因+0.5μg/ml舒芬太尼;2组:0.075%罗哌卡因+0.5μg/ml舒芬太尼(宫口开3cm),0.125%罗哌卡因+0.5μg/ml舒芬太尼(宫口开≥3cm);3组:0.1%罗哌卡因+0.5μg/ml舒芬太尼(宫口开3cm),0.125%罗哌卡因+0.5μg/ml舒芬太尼(宫口开≥3cm);4组:0.15%罗哌卡因+0.5μg/ml舒芬太尼;5组:0.075%罗哌卡因+0.5μg/ml舒芬太尼(宫口开3cm),0.15%罗哌卡因+0.5μg/ml舒芬太尼(宫口开≥3cm);6组:0.1%罗哌卡因+0.5μg/ml舒芬太尼(宫口开3cm),0.15%罗哌卡因+0.5μg/ml舒芬太尼(宫口开≥3cm);7组:0.125%罗哌卡因+0.5μg/ml舒芬太尼(宫口开3cm),0.15%罗哌卡因+0.5μg/ml舒芬太尼(宫口开≥3cm)。观察各组VAS评分、产程时间、产后出血量、Bromage评分以及产后不良反应,同时观察新生儿Apgar评分。结果七组产妇镇痛后各时间点的VAS评分差异无统计学意义。2、3组潜伏期时程较1组明显缩短(P0.05),5、6组较4组明显缩短(P0.05)。4组活跃期时程较1组明显延长(P0.05)。2、3组出血量较1组明显减少(P0.05),5、6、7组出血量较2组明显增多(P0.05),同样也明显多于3组(P0.05)。2、3组产妇运动神经阻滞较1组轻微,且5、6、7组产妇运动神经阻滞较4组也明显减弱(P0.05)。各组产妇产后不良反应及新生儿Apgar评分差异无统计学意义。结论产程潜伏期应用0.075%或0.1%罗哌卡因+0.5μg/ml舒芬太尼,活跃期应用0.125%罗哌卡因+0.5μg/ml舒芬太尼,镇痛效果确切,对产程干扰小,产后出血量少,不影响产妇下肢活动,并且对母婴安全无明显影响。

Application of different doses of ropivacaine combined with sufentanil in epidural stepwise labor analgesia LI

Objective To evaluate the efficacy of epidural anesthesia combined with different doses ropivacaine and sufentanil for stepwise labor analgesia in latent phase.Methods Two hundred and ten ASA Ⅰ or Ⅱ primiparas with a singleton and vertex presentation at full term in our hospital from February 201 5 to April 201 5 were randomized into seven groups (n =30 each):0.125% ropiva-caine with 0.5 μg/ml sufentanil (group 1);0.075% ropivacaine with 0.5 μg/ml sufentanil (cervical dilatation < 3 cm),0.125% ropivacaine with 0.5 μg/ml sufentanil (cervical dilatation ≥ 3 cm) (group 2);0.1% ropivacaine with 0.5 μg/ml sufentanil (cervical dilatation < 3 cm),0.125% ropiv-acaine with 0.5 μg/ml sufentanil (cervical dilatation≥3 cm)(group3);0.1 5% ropivacaine with 0.5μg/ml sufentanil (group 4);0.075% ropivacaine with 0.5 μg/ml sufentanil (cervical dilatation < 3 cm),0.1 5% ropivacaine with 0.5 μg/ml sufentanil (cervical dilatation≥ 3 cm)(group 5 );0.1%ropivacaine with 0.5 μg/ml sufentanil (cervical dilatation<3 cm),0.1 5% ropivacaine with 0.5 μg/ml sufentanil (cervical dilatation≥3 cm)(group 6);0.125% ropivacaine with 0.5 μg/ml sufentanil (cervical dilatation<3 cm),0.1 5% ropivacaine with 0.5 μg/ml sufentanil (cervical dilatation≥3 cm) (group 7).The intensity of pain was assessed by visual analog scale (VAS).Meanwhile,1abor process,postpartum hemorrhage,Bromage score,postpartum adverse reactions and Apgar score of the neonates were also observed.Results No significant difference was found in VAS score after epi-
dural block between groups at each time.The latent period of group 2 and 3 were shorter than that in group 1 (P <0.05)and that of group 5 and 6 were shorter than that in group 4 (P <0.05);the ac-tive phase of group 4 were longer than that in group 1 (P <0.05 ).The postpartum hemorrhage of group 2 and 3 were less than that in group 1 (P <0.05),the postpartum hemorrhage of group 5,6 and 7 were more than that in group 2 (P <0.05)and group 3 (P <0.05).The motor nerve block of group 2 and 3 were slightly less than that in group 1 (P <0.05)and the motor nerve block of group 5,6 and 7 were slightly less than that in group 4 (P <0.05).There was no difference of the postpar-tum adverse reactions of maternal and Apgar score in the neonates.Conclusion The dosage of 0.075% or 0.1% ropivacaine with 0.5 μg/ml sufentanil (cervical dilatation < 3 cm),0.125% ropiv-acaine with 0.5 μg/ml sufentanil (cervical dilatation ≥ 3 cm),while producing the exact analgesic effect,hardly interferes with the 1abor process,the amount of postpartum hemorrhage and the lower limb activity,thus they have no significant effect on the safety of the maternal and the infant.