摘要
目的 采用不同浓度的罗比卡因伍用小剂量芬太尼作硬膜外分娩镇痛 ,探讨较适宜的药物浓度 (RP)。方法 选择足月、单胎头位初产妇 12 0例 ,ASAⅠ～Ⅱ级 ,随机分成四组 ,每组 30例。所用药物 :A组 0 0 75 %罗比卡因 ;B组 0 12 5 %罗比卡因 ;C组 0 2 %罗比卡因 ,每组均加 2 μg/ml芬太尼 ;D组为对照组 ,未行分娩镇痛 ,于产程进展宫口开 3cm时 ,行硬膜外腔穿刺置管 ,首次剂量 8～ 12ml;30min后 ,连接PCA泵 ,维持量为 5～ 12ml/h持续硬膜外腔输注至宫口开全停药 ,PCA剂量 4ml,锁定时间 2 0min。用视觉模拟评分 (VAS)和改良Bromage评分评估镇痛、运动神经阻滞情况 ,观察记录各组产妇的生命体征、产程时间、分娩方式及新生儿Apgar评分。 结果A、B、C与D组相比 ,产妇用药后VAS评分均明显降低 ,且A、B、C组第一产程均较对照组明显缩短 (P <0 0 1)。但A组的镇痛效果欠佳 ,VAS评分高于B、C组 (P <0 0 1)。C组的难产率较高 ,与对照组相比有显著差异 (P <0 0 1)。B组镇痛效果最满意。宫口扩张速度和胎头下降速度较快 ,分娩中产妇的BP、HR、RR平稳 ,对产程和分娩方式及新生儿Apgar评分均无明显影响 ,联合用药可减少局麻药用量。结论 0 12 5 %罗比卡因伍以芬太尼用于硬膜外分娩镇痛对产程影响小 ,镇痛效果确?
Objective To evaluate a proper concentration of ropivacaine during patient controlled epidual analgesia(PCEA) used for labor analgesia by comparing the effects of different concentrations of ropivacaine and fentanyl Methods 120 ASA I II primiparous with a full term singleton fetus in the vertex presentation were randomly divivded into 4 groups: group A, 0 075% ropivacaine+fentanyl 2μg/ml; group B, 0 125% ropivacaine+fentanyl 2μg/ml; group C, 0 2% ropivacaine+fentanyl 2μg/ml; group D, without PCEA as a control Epidural catheter was placed during active labour with 3cm cervical dilatation The initial dose was 8 12ml and continuous pumping(5 12ml/h) started at 30min after that in group A,B and C All drugs were stopped at the beginning of the second stage (10 cm cervical dilatation) PCA bolus dose was 4ml The visual analogue scale(VAS) was obtained before and during labor analgesia Degree of motor block was evaluated using modified Bromage score at the same times The vital signs, duration of labor, mode of delivery and the neonatal Apgar score were observed Results All parturients had a better pain relif and shorter first stage of labor in group A, B and C than those in the control ( P< 0 01) The VAS of group A was higher than that of group B and C The rate of difficult labor was higher in group C than that in group D The effect of labor analgesia in group B was the best with quiker cervical dilation, fetus head down and stable maternal BP,HR, SpO 2, FHR, and Apgar scores Conclusion PCEA using 0 125% ropivacaine with fentanyl has a better analgesia, less effect on labor stage and is a suitable choice for labor analgesia
出处
《临床麻醉学杂志》
CAS
CSCD
2003年第8期463-465,共3页
Journal of Clinical Anesthesiology
