不同浓度罗哌卡因在硬脊膜穿破硬膜外阻滞分娩镇痛的效果  

Investigation on the efficacy of ropivacaine with different concentrations on epidural block for labor analgesia after dural puncture

作　　者：陈永华 梁太汉 陈秋月 CHEN Yonghua;LIANG Taihan;CHEN Qiuyue(Department of Anesthesia,Yangjiang Maternal and Child Health Hospital,Guangdong,Yangjiang 529500,China)

机构地区：[1]广东省阳江市妇幼保健院麻醉科,广东阳江529500

出　　处：《中国医药科学》2021年第13期142-145,157,共5页China Medicine And Pharmacy

基　　金：广东省阳江市医疗卫生类科技计划项目(SF2020091)。

摘　　要：目的对比不同浓度罗哌卡因在硬脊膜穿破硬膜外阻滞分娩镇痛应用效果。方法选择阳江市妇幼保健院2020年5月至2020年10月经阴道分娩要求行分娩镇痛的足月初产妇150例为研究对象,按照随机数字表法分为三组。A组(50例):0.065%罗哌卡因+0.3μg/ml舒芬太尼;B组(50例):0.08%罗哌卡因+0.3μg/ml舒芬太尼;C组(50例):0.1%罗哌卡因+0.3μg/ml舒芬太尼。观察并记录镇痛前(T_(0))、镇痛后15 min(T_(1))、镇痛后30 min(T_(2))、镇痛后1 h(T_(3))、第二产程(T_(4))、会阴缝合(T_(5))时视觉模拟疼痛评分(VAS)与下肢运动神经阻滞程度,并观察起效时间、自控次数、器械助产、中转剖宫产、产妇不良反应、新生儿Apgar评分及满意率情况。结果T_(4)~T_(5)时间点VAS评分A组明显高于B、C两组,差异有统计学意义(P<0.05);T_(3)~T_(5)时间点Bromage评分C组高于A、B组,差异有统计学意义(P<0.05);A组自控次数高于B、C两组,差异有统计学意义(P<0.05);B组满意率高于A、C组,差异有统计学意义(P<0.05)。结论硬脊膜穿破硬膜外阻滞分娩镇痛中0.08%浓度与0.1%浓度罗哌卡因在第二产程与会阴缝合时镇痛效果优于0.065%浓度,0.065%浓度与0.08%浓度罗哌卡因在镇痛后1 h、第二产程、会阴缝合时对下肢运动神经阻滞程度较小,0.08%浓度与0.1%浓度罗哌卡因自控次数总体低于0.065%浓度,0.08%浓度罗哌卡因产妇满意度更高。Objective To compare the application efficacy of ropivacaine with different concentrations on epidural block for labor analgesia after dural puncture.Methods A total of 150 full-term puerperae who required labor analgesia during vaginal delivery admitted to Yangjiang Maternal and Child Health Hospital from May 2020 to October 2020 were selected as the research objects,and they were divided into group A(with 0.065%ropivacaine+0.3μg/ml sufentanil,n=50),group B(with 0.08%ropivacaine+0.3μg/ml sufentanil,n=50)and group C(0.1%ropivacaine+0.3μg/ml sufentanil,n=50)according to the random number table method.Visual analogue pain score(VAS)and degree of motor nerve block in lower limbs before analgesia(T_(0)),15 min after analgesia(T_(1)),30 min after analgesia(T_(2)),1 h after analgesia(T_(3)),the second stage of labor(T_(4))and perineal suture(T_(5))were observed and recorded.The onset time,self-control times,instrumental midwifery,transfer to cesarean section,maternal adverse reactions,neonatal Apgar score and satisfaction rate were observed as well.Results The VAS score at timepoint of T_(4)-T_(5)in group A was significantly higher than that in group B and C,with statistically significant difference(P<0.05).The Bromage score at timepoint of T_(3)-T_(5)in group C was higher than that in group A and B,with statistically significant difference(P<0.05).The self-control times in group A was higher than that in group B and C,with statistically significant difference(P<0.05).The satisfaction rate of group B was higher than that of group A and C,with statistically significant difference(P<0.05).Conclusion In the application of epidural block for labor analgesia after dural puncture,the analgesia efficacy of ropivacaine with concentration of 0.08%and 0.1%is better than that of 0.065%in the second stage of labor and the time of perineal suture.While ropivacaine with concentration of 0.065%and 0.08%has less degree of motor nerve block in lower limbs 1 hour after analgesia,the second stage of labor and the time of perineal sutu

关 键 词：罗哌卡因 硬脊膜穿破硬膜外阻滞 阴道分娩 分娩镇痛 满意度 

分 类 号：R614.4[医药卫生—麻醉学]