罗哌卡因复合芬太尼硬膜外用药对分娩方式的影响  

Effect of epidural ropivacaine and fentanyl for labor analgesia on mode of delivery

作　　者：卢园园[1] 刘绪华[1] 杨芳骅 钱小伟[1] 安秀君[1] 李军[1] 

机构地区：[1]温州医科大学附属第二医院麻醉科,325027

出　　处：《浙江医学》2016年第1期32-35,共4页Zhejiang Medical Journal

基　　金：温州市科技局项目(Y20110163)

摘　　要：目的探讨硬膜外罗哌卡因复合芬太尼分娩镇痛对分娩方式的影响。方法回顾7136例具备顺产条件初产妇的最终分娩方式。按产妇意愿分为对照组（A组）4168例及分娩镇痛组（B组）2968例。A组产妇未接受分娩镇痛，B组产妇给予L2-3或L3-4硬膜外阻滞，头向置管后1％利多卡因5ml试验量确定阻滞平面后，予以6～15ml／h持续泵注0．15％罗哌卡因和2μg／ml芬太尼的复合液。记录汇总最终分娩方式及剖宫产原因，评定两组新生儿出生后1、5min Apgar评分。评定产妇镇痛后的视觉模拟评分（VAS）及改良Bromage评分。结果B组产妇剖宫产率（20．28％）及产钳使用率（4．38％）明显高于A组（7．70％、2．33％，P〈0．01）；B组第一产程时间延长于A组（P〈0．01）；B组因第一产程延长而行剖宫产比例（64．62％）明显高于A组（42．81％，P〈0．01）；B组胎儿宫内窘迫的比例（12．29％）明显低于A组（31．25％。P〈0．01）；胎头下降停滞及羊水问题、胎位异常比例与A组比较差异均无统计学意义（均P〉0．05）。两组新生儿出生后1、5min的Apgar评分差异无统计学意义（P〉0．05）。B组产妇宫口16、10cm时的VAS评分明显低于A组（P〈0．01），但两组产妇下肢改良Bromage评分差异无统计学意义（P〉0．05）。结论0．15％罗哌卡因复合2μg／ml芬太尼的硬膜外分娩镇痛可增加产妇剖宫产率、阴道器械助产率及延长第一产程，但对新生儿Apgar评分及产妇下肢肌力无影响。Objective To investigate the effect of rcpivacaine/fentanyl for epidural labor analgesia on mode of delivery. Methods In this retrospective study, 7136 primiparas with nature labor were divided into control group （group A, n=4168） and epidural labor analgesia group （group B, n=2 968） according to the maternal intend. Besides routine care, primiparas in group A did not receive any analgesia. In group B, epidural analgesia was provided in L2-3 or L3-4 by a bolus injection of 5 ml of 1% lidocaine and maintained by using a continuous infusion of ropivacaine 0.15% plus fentanyl 2 μ l/ml at 6-15ml/h rate. The outcome of final delivery mode,the reason for cesarean section, neonatal Apgar score at land 5 min, visual analogue scale（VAS ）score and modified Bromage score after labor analgesia were recorded. Results The rate of cesarean section（20.28%） and forceps utilization（4.38%） in group B was significantly higher than those in group A （7.70%, 2.33%, P〈0.01）. The first stage of labor in group B was longer than that in group A （P〈0.01）. The proportion of cesarean delivery rate due to extension of the first stage of labor was higher in group B than that in group A （64.62% vs 42.81%, P〈0.01）. The proportion of fetal distress in uterus was lower in group B than in group A （12.29% vs 31.25%, P〈0.01）. There was no significant difference in descending of fetal head, the problems of amniotic fluid, position of the fetus, the duration of the second stage of labor, neonatal Apgar score at 1 and 5 rain between two groups. VAS score when the cervix dilated to 6cm and 10 cm was significantly lower in group B than that in group A （P〈0.01）, whereas the modified Bromage score was similar in two groups. Conclusion Epidural analgesia with 0.15% ropivacaine plus 2 μ g/ml fentanyl may significantly increase the rate of cesarean delivery and vaginal instrumental delivery, and extend the duration of first labor stage; but it has no effects on neonatal Apgar score and maternal lower limb musc

关 键 词：分娩镇痛 硬膜外阻滞 罗哌卡因 芬太尼 第一产程 

分 类 号：R614[医药卫生—麻醉学]