左旋布比卡因与罗哌卡因应用于分娩镇痛的临床研究  

A clinical study of levobupivacaine and ropivacaine used in combined spinal and epidural anesthesia for labor analgesia

作　　者：邓友明[1] 常胜和[1] 

机构地区：[1]东南大学附属南京江北人民医院麻醉科,江苏省南京市210048

出　　处：《中国厂矿医学》2007年第6期579-580,共2页Chinese Medicine of Factory and Mine

摘　　要：目的观察应用左旋布比卡因和罗哌卡因联合椎管内麻醉分娩镇痛的效果和安全性及对产妇和胎儿的影响。方法选择单胎足月初产妇ASA1～2级要求分娩镇痛者,随机分为左旋布比卡因组(L组)30例,罗哌卡因组(R组)30例,另随机选择不予镇痛自然分娩初产妇为对照组(D组)30例,观察镇痛效果VAS评分、运动阻滞程度(改良Brimage法)、生命体征、胎心率、产后出血量、Apgar评分、产程、分娩方式。结果生命体征平稳,胎心率、产后出血量、Apgar评分、产程比较无显著差异并(P>0.05)。L与R组镇痛效果确切,应用前后及与D组比较均有显著差异(P<0.05),L与R组运动阻滞程度无显著差并(P>0.05)。3组剖宫产率比较无显著差异(P>0.05)。结论左旋布比卡因和罗哌卡因应用于联合椎管内麻醉分娩镇痛是安全有效的方法。Objective To investigate the effect and safety of combined spinal and epidural anesthesia with levobupivaeaine and ropivaeaine for both mother and infant. Methods Thirty patients with full term primiparae at ASA 1 - 2 were administered for combined spinal and epidural anesthesia with levobupivaeaine during labor（ group L）, and thirty with ropivaeaine（ group R） ,in adddition thirty were spontaneous labor as the control（ group D）. When the ostium uteri was dilated to 1 -3em ,the spinal was performed with 0. 25% levobupivacaine 2ml in group L,whieh was followed after 15 min by PCEA with 0. 125% levobupivaealne and fentanyl （2 ug/ml）. In the group R levobupivaeaine was superseded by ropivaeaine. Level of pain （ VAS score） , degree of motor block （ modified Bromage score ） , vital signs, fetal heart rate, capacity of postpartum hemorrhage, Apgar score, duration of labour and mode of delivery were recorded and compared, Results The vital signs in group L and R were stable. There were no differences in Apgar score, fetal heart rate, duration of labour, capacity of postpartum hemorrhage and mode of delivery among three groups （all P 〉 0. 05）. The effect of analgesia in the group L and R was definitive;the difference was significant before and after administration, and also significant compared with the D （all P 〈 0.01 ）. The degree of motor block in group L was no difference compared with in group R（ P 〉 0. 05）. Conclusions The combined spinal and epidural analgesia with levobupivacaine and ropivaeaine provides satisfactory analgesia during labor, and it is safe and effective for both mother and infant.

关 键 词：左旋布比卡因 罗哌卡因 分娩镇痛 联合椎管内麻醉 

分 类 号：R614.4[医药卫生—麻醉学]