不同浓度罗哌卡因复合舒芬太尼用于分娩镇痛效果的比较  

The influences of ropivacaine 0.1% or 0.15%plus sufentanil 0.4 μg/ml for patient-controlled epidural analgesia on the mothers and infants during labor

作　　者：荣芳省[1] 张加强[1] 孟凡民[1] 

机构地区：[1]河南省人民医院麻醉科,450003

出　　处：《中国实用医药》2008年第25期13-14,共2页China Practical Medicine

摘　　要：目的比较不同浓度罗哌卡因复合舒芬太尼分娩镇痛的效果及对产妇及新生儿的影响,探讨罗哌卡因硬膜外分娩镇痛的合适浓度。方法足月妊娠初产妇40例,ASAⅠ～Ⅱ级,年龄22～32岁,根据舒芬太尼不同浓度随机分为3组,每组20例。采用持续硬膜外镇痛,Ⅰ组配药方法:0.1%的罗哌卡因复合0.4μg/mll舒芬太尼;Ⅱ组配药方法:0.15%的罗哌卡因复合0.4μg/ml舒芬太尼。分别记录PCEA前及后10、30、60min及宫口开全时和胎儿娩出时的VAS评分。记录产妇血氧饱和度,取脐静脉血行血气分析。并观察产程进展情况,产后出血量及新生儿Apgar评分。结果两组患者潜伏期比较无统计学意义,活跃期、第二产程及总产程Ⅱ组与I组比较有统计学意义(P<0.05)。I组和Ⅱ组的罗哌卡因总需要量分别为(48±8)mg和(61±10)mg,两组间比较有统计学意义(P<0.05)。无痛分娩开始后各时间点Ⅱ组的VAS评分与I组比较无统计学意义(P>0.05);与PCEA前比较,两组PCEA后各时间点VAS评分均显著降低(P<0.05或0.01)。Ⅱ组产妇SpO2和I组比较差异无统计学意义(P>0.05)。两组产妇的脐血pH值、PCO2及脐血PO2比较差异无统计学意义(P>0.05)。结论0.1%的罗哌卡因复合0.4μg/ml的舒芬太尼可达到较好镇痛效果,不影响产程进展,对产妇及新生儿影响小,是可行走式分娩镇痛的理想选择。Objective To investigate the effect of ropivacaine 0. 1% or 0. 15% plus sufentanil 0.4 μg/ ml for patient-controlled epidural analgesia on the mothers and infants during labor. Methods Twenty patients （ASA Ⅰ or Ⅱ ）undergoing labor were randomly divided into two groups with 20 cases each. Group I received ropivacaine 0. 1% ＋ sufentanil 0.4 μg/ml for PCEA, group Ⅱ with 0. 15% ropivacaine ＋ sufentanil 0. 4 μg/ml. The analgesia effects were evaluated by visual analogy score （VAS）. The degree of pain, duration of the labor, way of delivery, bleeding volume, rate of anoxia of new born, blood gas analysis to maternal radius artery and fetal umbilical blood of 3 groups were observed. Results The duration of the latent phase of labor was similar in both groups. But the duration of the active phase and the second stage of labor were longer in group Ⅱ than group Ⅱ （ P 〈 0. 05 ）. The mean total dose of ropivacaine in Group 0. 10% was less than in Group 0. 15% （ P 〈 0. 05 ）. Mean VAS pain scores at baseline and throughout labor showed no difference between groups. The incidence of side effects, including nausea, pruritus, and somnolence, as well as patient satisfaction, PCEA characteristics, need for supplemental boluses,and Apgar scores,was also similar between groups. SpO2 of mothers in group Ⅲ was significantly lower than that in group Ⅰ （P 〈 0. 05 ）. The blood analysis to maternal radius artery, fetal umbilical blood and the rate of anoxia of new borns of two groups revealed no significant differences （ P 〉 0. 05 ）. Conclusion Ropivacaine 0. 10% plus 0. 5 μg/ml of sufentanil given via PCEA for labor analgesia was found to be equally effective when compared with ropivacaine 0. 15% plus 0. 5 μg/ml of sufentanil.

关 键 词：罗哌卡因 分娩镇痛 硬膜外自控镇痛 

分 类 号：R614[医药卫生—麻醉学] R714.3[医药卫生—外科学]