比较不同容量局麻药硬膜外规律间断注射分娩镇痛的效果  

Comparison of the efficacy of different local anesthetic volumes used in epidural regular intermittent injection during labor analgesia

作　　者：张引吉[1] 蔡明珍[1] 徐华琴[1] 朱新杰[1] 丁秀花[2] 徐振兴[1] 何亮亮[1] 翁浩[1] 

机构地区：[1]上海交通大学附属第六人民医院奉贤分院麻醉科,201400 [2]上海交通大学附属第六人民医院奉贤分院妇产科,201400

出　　处：《实用疼痛学杂志》2013年第5期344-348,共5页Pain Clinic Journal

摘　　要：目的 比较硬膜外规律间断注射不同容量局麻药在分娩镇痛中的临床效果.方法 行分娩镇痛初产妇60例,随机分为4 ml组（A组）、6 ml组（B组）和8 ml组（C组）.分别规律间断硬膜外注射0.125％罗哌卡因与舒芬太尼0.4μg·m1-1 4、6、8 ml·h-1,均无背景输注剂量.记录疼痛VAS评分、PCEA追加次数、麻醉药物用量、最高阻滞平面、不良反应发生率等.结果 与镇痛前相比,3组产妇在实施分娩镇痛后VAS均降低（P＜0.05）,但3组间VAS比较差异无统计学意义（P＞0.05）.与B、C组相比,A组PCEA追加次数明显增多（P＜0.05）；与A、B组相比,C组罗哌卡因与舒芬太尼用量明显增加（P＜0.05）.宫口开全时,A组最高阻滞平面最低（P＜0.05）,C组最高阻滞平面最高（P＜0.05）.结论 硬膜外以4、6、8 ml·h-1规律间断注射0.125％罗哌卡因与0.4 μg＆#183;ml-1舒芬太尼镇痛效果均确切.由于4 ml组PCEA追加次数多而8 ml组用药量大,建议选择硬膜外规律间断注射镇痛液6 ml·h-1行分娩镇痛.Objective To evaluate the clinical efficacy of epidural regular intermittent injection with different local anesthetic volumes in labor analgesia. Methods Sixty primiparae were randomly divided into three groups： group of 4 ml （group A）, group of 6 ml （group B） and group of 8 ml （group C）. The parturients in the three groups received epidural regular intermittent injection with 0. 125% ropivacaine and sufentanil 0.4 μg·ml^-1 in bolus 4,6,8 ml·h^-1 respectively without back- ground continuous infusion dose. VAS, the press times of parturient controlled epidural analgesia （PCEA）, the consumption of ropivacaine and sufentanil, maximum blocked segment and the side- effects were recorded. Results VAS was significantly decreased after treatment in the three groups （P〈0.05）, but no significant difference was observed in VAS among the three groups （P〉0. 05）. The press times of PCEA were more in group A than those in group B and group C （P〈0. 05）, the consumption of ropivacaine and sufentanil was less in group A and group B than that in group C （P〈 0.05）. At the time of cervical orifice dilated completely, the maximum blocked segment was lowestin group A and highest in group C （P（0. 05）. Conclusion Epidural regular intermittent injection of 0. 125% ropivacaine and 0.4μg·ml^-1 sufentanil of 4 ml/h, 6 ml/h and 8 ml/h can all achieve satisfied clinical efficacy. Because of the more numbers of press times during PCEA in group of 4 ml and the larger consumption of local anesthetics in group of 8 ml, 6 ml·h^-1 is recommended.

关 键 词：分娩 镇痛 产科 注射 硬膜外 

分 类 号：R614[医药卫生—麻醉学]