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| 不同浓度罗哌卡因复合芬太尼用于程控硬膜外间歇脉冲注入分娩镇痛的效果 |
| Effect of different concentrations of ropivacaine combined with fentanyl in programmed intermittent epidural bolus on labor analgesia |
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| DOI：10.12089/jca.2019.11.005 |
| 中文关键词: 程控硬膜外间歇脉冲注入技术 分娩镇痛 局麻药 阿片类药物 |
| 英文关键词: Programmed intermittent epidural bolus Labor analgesia Local anesthetics Opioids |
| 基金项目:国家自然科学基金（81671888） |
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| 摘要点击次数: 2492 |
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| 中文摘要: |
目的 通过应用程控硬膜外间歇脉冲注入技术,观察给予不同浓度的罗哌卡因复合芬太尼组合进行分娩镇痛的效果及其安全性。
方法 分娩产妇72例,年龄22～38岁,ASA Ⅰ或Ⅱ级。随机分为0.075％罗哌卡因组(R0.075组),0.1％罗哌卡因组(R0.1组)和0.125％罗哌卡因组(R0.125),R0.075组给予0.075％罗哌卡因组复合芬太尼1 μg/ml,R0.1组给予0.1％罗哌卡因组复合芬太尼1 μg/ml, R0.125组给予0.125％罗哌卡因组复合芬太尼1 μg/ml,三组均应用程控硬膜外间歇脉冲注入技术进行分娩镇痛。记录所有产妇镇痛前(T0)、镇痛后10 min(T1)、镇痛后30 min(T2)、镇痛后1 h(T3)、镇痛后2 h(T4)、宫口开全时(T5)、胎儿娩出时(T6)的 VAS评分和下肢运动神经阻滞程度(Bromage)评分。记录新生儿体重和胎心率。记录新生儿出生后1、5 min的Apgar评分和24 h新生儿神经行为学(NBNA)评分。记录产妇镇痛时间和在镇痛期间恶心呕吐、低血压发热、尿潴留、皮肤瘙痒等不良反应发生情况和产妇满意度评分。
结果 T1—T6时R0.075组VAS评分明显高于R0.1组和R0.125组(P < 0.05)。T0—T6时R0.075组和R0.1组Bromage评分明显明显低于R0.125组(P < 0.05)。三组新生儿体重、胎心率、出生后1、5 min的Apgar评分和NBNA评分比较差异均无统计学意义。三组恶心呕吐、低血压、发热、尿潴留、皮肤瘙痒等不良反应差异无统计学意义。R0.1组产妇满意度明显高于R0.075组和R0.125组(P < 0.05)。
结论 与0.075％罗哌卡因和0.125％罗哌卡因的镇痛比较,通过程控硬膜外间歇脉冲注入技术应用0.1％罗哌卡因复合1 μg/ml芬太尼具有更佳的分娩镇痛效果,且不增加不良反应。 |
| 英文摘要: |
Ojective To observe the effects of different concentration of ropivacaine combining fentanyl for labor analgesia by programmed intermittent epidural bolus.
Methods Seventy-two puerperae, aged 22-38 years, falling into ASA physical status Ⅰ orⅡ, were randomly divided into 3 groups: group R0.075 (0.075％ ropivacaine), group R0.1 (0.1％ ropivacaine) and group R0.125 (0.125％ ropivacaine), puerperae were treated by 0.075％ ropivacaine and 1 μg/ml fentanyl in the group R0.075, 0.1％ ropivacaine and 1 μg/ml fentanyl in the group R0.1 and 0.125％ ropivacaine and 1 μg/ml fentanyl in the group R0.125 by programmed intermittent epidural bolus. Visual analog score (VAS) and lower extremity motor block score (Bromage) were measured before all women with analgesia (T0), 10 min after analgesia (T1), 30 min after analgesia (T2), 1 h after analgesia (T3), 2 h after analgesia (T4), full cervix (T5), and time of delivery (T6) were recorded. Neonatal weight, fetal heart rate, Apgar scores at 1 min and 5 min after birth and neonatal neurobehavioral scores (NBNA) at 24 h after birth were measured. The duration of analgesia and adverse reactions such as pruritus, nausea and vomiting, hypotension, urinary retention and fever during analgesia and maternal satisfaction scores were recorded.
Results Compared with group R0.075, VAS was significantly lower at T1-T6 in group R0.1 and group R0.125 (P < 0.05). Compared with group R0.075 or group R0.1 at T0-T6, Bromage score was significantly higher in group R0.125 (P < 0.05). There were no significant differences of neonatal weight, fetal heart rate, Apgar score and NBNA score at 1 and 5 min after birth among the three groups. There was no significant difference of skin itching, nausea and vomiting, hypotension, fever and urinary retention among the three groups. The satisfaction in group R0.1 was significantly higher than that of group R0.075 and group R0.125 (P < 0.05).
Conclusion Compared with 0.075％ ropivacaine and 0.125％ ropivacaine, 0.1％ ropivacaine with 1 μg/ml fentanyl by programmed epidural intermittent pulse injection technology has better analgesic effects in labor without increasing adverse reactions. |
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