不同剂量罗哌卡因复合芬太尼行阶梯式分娩镇痛效果比较  

Effect comparison of the different doses of ropivacaine combined with fentanyl for stepwise labor analgesia

作　　者：赵君钱 燕宁 ZHAO Jun;QIAN Yanning(Jiangning Hospital,Nanjing Medical University,Nanjing,Jiangsu Province,211101)

机构地区：[1]南京医科大学附属南京市江宁医院,211101

出　　处：《中国计划生育学杂志》2023年第7期1606-1611,共6页Chinese Journal of Family Planning

摘　　要：目的:探讨不同剂量罗哌卡因复合芬太尼行阶梯式分娩镇痛效果。方法:选择2022年1月—2022年6月本院拟行分娩镇痛的待产妇165例,,随机数字表法分为对照组、阶梯1组、阶梯2组,3组均于L_(3-4)间隙行硬膜外分娩镇痛,镇痛药物配方为0.1%盐酸罗哌卡因+2.0μg/ml枸橼酸芬太尼共100 ml,负荷量8 ml,单次按压剂量6 ml,间隔时间15 min。对照组全程脉冲剂量6 ml/h;宫颈口扩张至5 cm后,阶梯1组输注的脉冲量改为8 ml/h,阶梯2组为10 ml/h。在宫颈口扩张至10 cm后3组均停用镇痛泵。记录宫颈口扩张至2 cm、5 cm、10 cm时以及胎儿娩出时产妇的VAS评分、改良Bromage评分、宫缩情况。记录各产程时间、镇痛泵输注总用药量、缩宫素使用情况、分娩方式以及不良反应,记录胎心变化、新生儿出生后Apgar评分。结果:宫颈口扩张至10 cm和胎儿娩出时VAS评分对照组、阶梯1组、阶梯2组依次降低,总产程、第一产程时间对照组、阶梯1组、阶梯2组依次缩短,镇痛泵输注总用药量对照组、阶梯1组、阶梯2组依次减少(均P<0.05)。3组缩宫素使用率、Bromage评分、胎心变化、不良反应、分娩结局及新生儿Apgar评分无差异(P>0.05)。结论:宫颈口扩张至5cm时增加输注罗哌卡因复合芬太尼剂量行阶梯式分娩镇痛安全有效,可降低产妇VAS疼痛评分,缩短总产程、第一产程时间,减少镇痛泵输注总用药量,未增加不良反应。输注剂量10 ml/h时镇痛效果更好。Objective:To investigate the effect comparison of the different doses of ropivacaine combined with fentanyl for stepwise labor analgesia.Methods:A total of 165 full-term pregnant women who wanted labor analgesia were selected and were divided into three groups by random number table method from January 2022 to June 2022.The women in the three groups were given epidural labor analgesia in the L3-L4 space,and the analgesic drug formulation was 100 ml of 0.1%ropivacaine hydrochloride combined with 2.0μg/ml fentanyl citrate,with the load was 8 ml,the single pressing dose was 6 ml,and the interval was 15 min.The women in group C were given the hourly pulsed bolus dosage of 6 ml during labor.The women in group A or in group B were given the hourly pulsed bolus dosage of 6 ml firstly,and then after the cervical opening to 5 cm,the infusion pulse volume was changed to 8 ml/h or 10 ml/h.Analgesic pump was stopped for the women in the three groups after their cervical opening to 10 cm.The VAS score,the modified Bromage score,and the uterine contraction situation of the women in the three groups were recorded when the cervix opening to 2 cm,5 cm,and 10 cm,and at the time of delivery.The total labor time,the total dosage of analgesic drugs by pump infusion,the situation of oxytocin used,the delivery mode,the adverse reactions,the fetal heart changes,and the scores of neonatal Apgar of the women in the three groups were also recorded.Results:The VAS score of women at the cervix opening to 10 cm and at delivery in group C,group A,and group B had decreased gradually.The durations of the total labor and the first stage of labor of women in group C,group A,and group B had shortened gradually.The total dosage of analgesic drugs by pump infusion of women in group C,group A,and group B had decreased gradually(all P<0.05).There were no significant differences in the rate of oxytocin used,the Bromage score,the fetal heart rate change,the adverse reactions rate,the delivery outcomes,and the neonatal Apgar score of the women among the

关 键 词：硬膜外分娩镇痛 阶梯式分娩镇痛 罗哌卡因 芬太尼 效果 产程 新生儿 

分 类 号：R714.3[医药卫生—妇产科学]