低浓度罗哌卡因复合舒芬太尼硬膜外麻醉用于分娩镇痛的临床研究

目的 探讨罗哌卡因复合舒芬太尼硬膜外自控镇痛（PCEA）用于分娩镇痛的疗效及安全性.方法 按入院先后顺序,180例ASA Ⅰ～Ⅱ级,头位、单胎足月妊娠的初产妇被随机分为观察组与对照组各90例.观察组：在宫口开大3 cm时进行硬膜外穿刺,于硬膜外腔注入0.15％罗哌卡因＋0.5μg/ml舒芬太尼混合液10ml,PCEA基础注药速度6 ml/h,自控镇痛量为2ml,锁定时间为15min;对照组：临产前6小时起不予阿片类镇痛药,按产科常规处理.观察两组产妇镇痛效果、运动能力、产程、分娩方式、失血量及新生儿Apgar评分等项目.结果 观察组的镇痛有效率达100％.观察组的第一产程时间为（119±51）min,第二产程（56±30）min,均较对照组明显缩短;观察组顺产率（94％）高于对照组（70％）,组间差异均有统计学意义（P＜0.05）;对运动能力影响、产妇出血量及新生儿Apgar评分比较,组间差异无统计学意义（P＞0.05）.结论 低浓度罗哌卡因复合舒芬太尼PCEA用于分娩镇痛的临床效果好,能提高产科质量,方法简便、安全、高效.

Low concentrations ropivacaine combined with fentanyl epidural anesthesia in labor analgesia

Objective To explore the efficacy and safety of ropivacaine combined with sufentanil epidural analgesia （PCEA） for labor analgesia.Methods According to the order of admission,180 cases with ASA Ⅰ～ Ⅱ grade,head position and a single full-term pregnancy,fetal primipara were randomly divided into observation group and control group （n =90）.Observation group：cervix 3 cm when epidural puncture in epidural 0.15% ropivacaine 0.5μg/ml sufentanil mixture 10ml.PCEA basic injection rate 6 ml / h,the amount of analgesia 2ml,lockout time 15min.Control group：6h before labor starting opioid analgesics according to obstetric conventional treatment.Maternal analgesia,athletic ability,labor,mode of delivery,blood loss and neonatal Apgar score were observed.Results The effective rate of 100% of the analgesic.The first stage of the observation group （119±51） min and the second stage （56±30） min of the observation group were significantly shorter than that of the control group.The observation group birth rate （94 %）was higher than that of the control group （70%）.The athletic ability,maternal hemorrhage and neonatal Apgar score of the two groups were statistically different （P〉0.05）.Conclusion Low concentrations of ropivacaine PCEA sufentanil for labor analgesia can improve the quality of obstetric,which is simple,safe and efficient.