摘要
目的 探索分娩期硬膜外腔用药镇痛的镇痛效果和安全性。方法 60例ASAⅠ～Ⅱ级单胎足月初产妇 ,前瞻随机分为 4组 :RⅠ组 :硬膜外 0 12 5 %罗哌卡因组 (n =15 )、RⅡ组 :硬膜外 0 2 %罗哌卡因组 (n =15 )、B组 :硬膜外0 12 5 %布比卡因组加芬太尼 2 μg/ml(n =15 )与C组 :空白对照组 (n =15 )。RⅠ组、RⅡ、B组在宫口张开 3cm时 ,经L2 -3置入硬外导管行分娩镇痛 ,采用首量 +持续背景剂量 +PCA模式给药 ,分别为 :首量 5ml,持续注射剂量 3～ 6ml/h ,PCA 3ml/次 ,C组为产科常规处理。临床观察 4组产妇的生命体征、镇痛评分、产程、下肢运动评分、催产素用量、器械助产分娩率和新生儿Apgar评分。结果 4组产妇生命体征稳定。RⅠ组、RⅡ组与B组均取得良好镇痛效果。与C组相比 ,RⅡ ,B组的器械助产率增加明显 (P <0 0 5 ) ,RⅠ组无差异。 4组间剖宫产率无明显差异。RⅡ ,B组的第二产程延长 16 1% ,18 3 % ,RⅠ组无产程延长。新生儿出生Apgar评分 4组无差异。结论 硬膜外镇痛分娩具有镇痛效果好、副作用少的特点 ,是目前最常用的方法。镇痛组均有良好的镇痛效果。 0 12 5 %布比卡因复合芬太尼 ( 2 μg/ml)会使第二产程延长 。
Objective To investigate the effect and safety of epidural analgesia for parturient delivery.Methods Sixty primiparae of ASA Ⅰ～Ⅱ with a term, single fetal were divided into four groups prospectively and randomly: RⅠ group, 0 125% ropivacaine, n =15; RⅡ group, 0.2% ropivacaine, n =15; B group, 0.125% ropivacaine+fentangl 2 μg/ml, n =15; C group, Control, n =15. When the cervix dilated to 3 cm, the parturients in RⅠ, RⅡ and B were catheterized by epidural L 2-3 . The administration mode was loading dose+continuous background dose+PCA. The loading dose was 5 ml, continuous dose 5～6 ml/h and PCA 3 ml every time. C group was treated as obstetrics routine. The vital signs, score of analgesia, birth process, motor ability of lower extremities, the consumed volumes of oxytocin, the instrumental delivery rate and the neonatal Apgar's score were observed. Results The vital signs in four groups were stable. Good effect of analgesia was obtained in RⅠ, RⅡ and B groups. Compared with C group, RⅡ and B groups had higher instrumental delivery rate ( P <0.05), while RⅠ group had no difference. The caesarean section rate had no significant difference among the four groups. The second birth process of the RⅡ and B groups was prolonged by 16.1% and 18.3%, while that of RⅠ group was not prolonged. The neonatal Apgar score had no difference among the four groups.Conclusion All groups with epidural analgesia can get good effect of analgesia. Epidural analgesia with 0 125% ropivacaine can produce good effect of analgesia and has no influence on the birth process. Epidural analgesia with 0.2% ropivacaine or 0.125% bupivacaine combined with fentangl 2 μg/ml may prolong the second birth process and increase the instrumental delivery rate.
出处
《广东医学》
CAS
CSCD
2000年第5期359-361,共3页
Guangdong Medical Journal
