摘要
目的 观察不同浓度罗比卡因应用于分娩镇痛的安全性与有效性 ,并与布比卡因进行比较。方法 选择足月、单胎、头位初产妇 88例 ,ASAⅠ～Ⅱ级 ,其中自愿接受分娩镇痛 48例 ,随机分为四组 (n =12 ) :(1) 0 2 %布比卡因 (B组 ) ;(2 ) 0 2 %罗比卡因 (R组 ) ;(3) 0 1%罗比卡因 +芬太尼 2 μg/ml间断注药 (RF组 ) ;(4) 0 1%罗比卡因 +芬太尼 2 μg/ml持续用药 (RFC组 )。对照组 40例未行分娩镇痛。于产程进展宫口开至 3cm时 ,行硬膜外腔穿刺置管 ,首次剂量 8～ 12ml。B组、R组和RF组按需追加 5～ 8ml/次 ,RFC组在给首量后半小时 ,用输液泵将维持量以 5～ 7ml/h持续硬膜外腔输注至宫口开全停药。结果 行分娩镇痛各组产妇用药后VAS评分均明显降低 ,感觉减退平面均在T10 以下 (T10 ～S4 ) ,Bromage评分均为 0级。罗比卡因各组宫口扩张速率和胎头下降速率较快。对产程和分娩方式和母胎均无明显影响。联合用药可减少局麻药用量。结论 罗比卡因应用于分娩镇痛对产程影响较小 ,联合用药更加优越 。
Objective To evaluate the safety and efficacy of ropivacaine and compare with that of bupivacaine for epidural analgesia in labour.Methods 88 ASA Ⅰ Ⅱ primiparous with a full term singleton fetus in the vertex presentation were selected in this study,48 primiparous who were voluntary to labour analgesia were randomly divided into 4 groups:(1)ropivacaine 0 2%(R);(2)bupivacaine 0 2%(B);(3)ropivacaine 0 1% with fentanyl 2μg/ml by intermittent top up(RF);(4)ropivacaine 0 1% with fentanyl 2μg/ml by a continuous infusion(RFC)( n= 12).The others were in control group ( n= 40).Epidural catheter were placed in active labour(cervical dilatation 3cm),and the initial dose was 8 12ml.Intermittent topup dose of 5 8ml were given when participants requested additional pain relieve in group R,B and RF.Continouse infusion(5 8ml/h) were received by parturients in group RFC.All drug were stopped at the beginning of the second stage(cervical dilatation 10cm).Results All parturients got pain relieve obviously after analgesia.There were no significant differences in verbal pain scores(about 30),sensory levels(T 10 S 4),motor blockade (Bromage 0)in analgesia group.The amount of local anesthetics used in group RF and RFC is significantly less than that in group R( P< 0 05).Rate of cervical dilation and fetus head decreased in group RF and RFC were greater than that of R and B( P> 0 05).Comparing to control group,stage duration and mode of delivery had no significant difference in group R,RF and RFC,except that second stage duration of group B prolonged.There also had no obvious influence in maternal BP,HR,SpO 2,FHR and apgar scores,bleeding amount and side effects.Conclusion Ropivacaine are safe and effective for epidural analgesia in labour,and it has more advantages co
出处
《临床麻醉学杂志》
CAS
CSCD
2001年第5期243-245,共3页
Journal of Clinical Anesthesiology
