氯普鲁卡因联合罗哌卡因在分娩镇痛中转剖宫产的应用  

Application of chloroprocaine combined with ropivacaine in conversion of labor epidural analgesia to cesarean delivery anesthesia

作　　者：戴珩[1] 甘霖 李静[1] 张臻 雷晓峰 Dai Heng;Gan Lin;Li Jing;Zhang Zhen;Lei Xiaofeng(Department of Anesthesiology,Chongqing Health Center for Women and Children(Women and Children's Hospital of Chongqing Medical University),Chongqing 401147,China)

机构地区：[1]重庆市妇幼保健院(重庆医科大学附属妇女儿童医院)麻醉科,重庆401147

出　　处：《国际麻醉学与复苏杂志》2024年第6期586-590,共5页International Journal of Anesthesiology and Resuscitation

基　　金：重庆市妇幼保健院院级科研课题面上项目(2021YJMS09)。

摘　　要：目的探讨氯普鲁卡因联合罗哌卡因在分娩镇痛中转剖宫产麻醉中应用的有效性及安全性。方法采用随机数生成器法将174例产妇分为碱化利多卡因组(A组,55例)、氯普鲁卡因组(B组,60例)、氯普鲁卡因联合罗哌卡因组(C组,59例)。A组硬膜外麻醉使用1.6%利多卡因,B组使用3%氯普鲁卡因,C组使用2%氯普鲁卡因+0.25%罗哌卡因。记录3组产妇年龄、孕周、体重指数(BMI)、美国麻醉医师协会(ASA)分级、分娩镇痛期间视觉模拟评分法(VAS)疼痛评分、麻醉起效时间、术始VAS疼痛评分、胎儿娩出时间、术中低血压发生率、静脉镇痛药使用率、新生儿1 min及5 min Apgar评分、术后2 h VAS疼痛评分、下肢运动神经阻滞评分(MBS)、神经并发症发生率、产妇满意度及产科医师满意度。结果B组、C组麻醉起效时间短于A组(均P<0.05),术始VAS疼痛评分、静脉镇痛药使用率低于A组(均P<0.05),产妇满意度、产科医师满意度高于A组(均P<0.05)。B组静脉镇痛药使用率高于C组(P<0.05)。A组、B组术后2 h VAS疼痛评分高于C组(均P<0.05)。其余指标差异无统计学意义(均P>0.05)。结论2%氯普鲁卡因+0.25%罗哌卡因硬膜外给药可安全、有效地应用于分娩镇痛中转剖宫产麻醉。Objective To explore the effectiveness and safety of the application of chlorprocaine combined with ropivacaine in conversion of labor epidural analgesia to cesarean section anesthesia.Methods According to the random number generator method,174 puerperas were divided into three groups:an alkalinized lidocaine group(group A,n=55),a procaine group(group B,n=60)and a chloroprocaine combined with ropivacaine group(group C,n=59).The epidural anesthetic drug was 1.6% lidocaine in group A,and 3% chloroprocaine for group B,while group C was given a mixture of 2% chloroprocaine+0.25% ropivacaine.The three groups were compared for age,gestational age,body mass index(BMI),American Society of Anesthesiologists(ASA)classification,Visual Analogue Scale(VAS)score during delivery analgesia,the time to onset of anesthesia,VAS score at the beginning of the operation,delivery time of the fetus,the incidence of intraoperative hypotension,the rate of intravenous analgesics use,neonatal 1 min and 5 min Apgar scores,VAS score at postoperative 2 h,the Modified Bromage Scale(MBS)scores,neurological complications,and the satisfaction of the mothers and obstetricians with anesthesia was also investigated.Results Compared with group A,group B and group C presented decreases in the time to onset of anesthesia(all P<0.05),decreases in VAS scores at the beginning of the operation and the rate of intravenous analgesics use(all P<0.05),and increases in the satisfaction of the mothers and obstetricians with anesthesia(all P<0.05).The rate of intravenous analgesics use in group B was higher than that in group C(all P<0.05).Group A and group B showed higher postoperative VAS scores than group C on postoperative 2 h(all P<0.05).There was no statistical differences in other indicators(all P>0.05).Conclusions Epidural administration of 2% chlorprocaine combined with 0.25% ropivacaine can be safely and effectively used for conversion of labor analgesia to cesarean section anesthesia.

关 键 词：分娩痛 镇痛 剖宫产 硬膜外麻醉 氯普鲁卡因 罗哌卡因 

分 类 号：R714.3[医药卫生—妇产科学]