摘要
目的 观察不同剂量罗哌卡因腰麻-硬膜外联合阻滞（CSEA）和产妇自控硬膜外镇痛（PCEA）在分娩镇痛中的效果和安全性以及对产程和胎儿的影响,以探讨最佳的方法和药物剂量。方法 随机选择ASAI～Ⅱ级拟行自然分娩的单胎足月初产妇100例,按双盲原则分为5组,宫口开至 3-4cm时,R1-3组分别经蛛网膜下腔注入 0.75％罗哌卡因0.33ml（2.5mg）、0.50ml（3.75mg）、0.67ml（5mg）,注入容积均为 2.5ml,用5％葡萄糖溶液添加。Y组单独硬膜外镇痛。C组为未实施分娩镇痛者作对照。R1-3各组当腰麻作用消失后,连接 PCA泵,经硬膜外均给予 0.175％罗哌卡因。输注背景速率为6ml/h,锁定时间 15min,单次剂量 2ml。Y组在孕妇宫口开至 3～4cm时给予0.175％罗哌卡因（方法同R1-3组）。监测 VAS评分及改良 Bromange评分;新生儿 Apgar评分及NACS评分;出生即刻的婴儿脐静脉血的血气分析测定,产程、镇痛时间及PCA泵用药量和按压次数,镇痛后及产后副作用。结果 镇痛起效时间:R1、R2、R3组显著短于Y组,有非常显著性差异（P<0.01）;Y组罗哌卡因用药量高于其它各组,有显著性差异（P<0.05）。CSEA各组中,随着蛛网膜下腔药量的增加,运动神经阻滞逐渐加深,三组间比较均有显著性差异（P<0.05或P<0.01）。结论蛛网膜下腔给予罗哌卡因3.75mg。
Objective To investigate the effect and safety of combined spinal-epidural analgesia (CSEA) with different doses of ropivacaine during labor. Methods One hundred ASA Ⅰ -Ⅱ full term primigravidae were randomly divided into 5 groups: group Rl (n =20), R2 (n =21), R3 (n = 21), group Y ( n = 19) and group C ( n = 20) . When the external cervical os was dilated to 3-4cm lumbar puncture was performed at L2-3 or L3-4 with a special CSE needle. 0.75% ropivacaine 0.33ml (2.5mg), 0.5ml (3.75mg) or 0.67ml (5mg) was added to 5% glucose with a total volume of 2.5ml and injected into subarachnoid space in group R1, R2 and R3 respectively. When subarachnoid block was wearing off, patient controlled-epidural analgesia (PCEA) with 0.175% ropivacaine was started (background infusion 6ml/h, bolus 2ml, lock-out time 15min) . In group Y patients received only PCEA with 0.175% ropivacaine and in group C patients received neither CSEA nor PCEA and served as control. Level of pain (VAS scores), degree of motor block (modified Bromage scores), Apgar scores and neurological and adaptive capacity scores (NACS), the progress of labor, the amount of ropivacaine used and side effects were recorded and compared. Blood samples were taken from umbilical vein for blood gas analysis immediately after delivery. Results Demographic data were comparable between groups and there were no significant differences in the progress of labor, Apgar score, NACS and blood gases of umbilical venous blood between groups. The onset of analgesia was significantly faster in group R1, R2 and R3 than that ingroup Y(P<0.01) . The total amount of ropivacaine used in group Y was significantly greater than that in CSEA groups ( P < 0.05 ) . The intensity of motor block increased with the increasing concentrations of intrathecal ropivacaine in group R1-3.Conclusions Subarachnoid ropivacaine 3.75mg followed by PCEA with 0.175% ropivacaine provides satisfactory analgesia with negligible side effects during labor and is safe for both mother and infant.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2002年第5期276-279,共4页
Chinese Journal of Anesthesiology
基金
河北省科委科技攻关项目(00276309D)
关键词
罗哌卡因
腰麻-硬膜外联合阻滞
分娩镇痛
研究
Amides
Anesthesia, spinal
Anesthesia, epidural
Analgesia, obstetric
Analgesia, patient- controlled
