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| 0.15%罗哌卡因与0.1%罗哌卡因复合舒芬太尼硬膜外分娩镇痛的比较 |
| Comparison of 0.15% ropivacaine and 0.1% ropivacaine combined with sufentanil in epidural labor analgesia |
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| DOI：10.12089/jca.2020.08.013 |
| 中文关键词: 罗哌卡因 舒芬太尼 分娩镇痛 瘙痒 |
| 英文关键词: Ropivacaine Sufentanil Labor analgesia Pruritis |
| 基金项目:吴阶平医学基金会临床科研专项资助基金（320.6750.18517） |
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| 中文摘要: |
目的 比较单用0.15%罗哌卡因与0.1%罗哌卡因复合舒芬太尼在硬膜外分娩镇痛的效果和不良反应。
方法 选择足月单胎初产妇257例，年龄18~40岁，BMI 18~35 kg/m2，随机分为两组，分别采用0.1%罗哌卡因+舒芬太尼0.5 μg/ml(A组，n=129)和0.15%罗哌卡因(B组，n=128)行硬膜外分娩镇痛。观察分娩镇痛前、硬膜外给药20 min后和产程中最大VAS疼痛评分，记录镇痛泵按压次数、补救镇痛次数、镇痛药物用量、改良Bromage评分、满意度、产程时间、分娩方式，新生儿出生后1 min和5 min的Apgar评分，记录镇痛期间皮肤瘙痒、恶心呕吐、尿潴留、产时发热等不良反应发生情况。
结果 两组在硬膜外给药20 min后和产程中最大VAS评分均明显低于分娩镇痛前（P＜0.05），但两组差异无统计学意义。两组镇痛泵按压次数、补救镇痛次数、麻醉药物用量、改良Bromage评分、满意度差异无统计学意义。两组产程时间、分娩方式、新生儿出生后1 min和5 min的Apgar评分差异无统计学意义。A组有10例(7.8%)皮肤瘙痒，而B组无一例皮肤瘙痒（P＜0.05）。两组恶心呕吐、尿潴留、产时发热发生率差异无统计学意义。
结论 单用0.15%罗哌卡因与0.1%罗哌卡因复合5 μg/ml舒芬太尼对初产妇硬膜外分娩镇痛效果相当，但单用罗哌卡因时皮肤瘙痒发生率明显降低。 |
| 英文摘要: |
Objective To compare the effect of 0.15% ropivacaine alone and 0.1% ropivacaine with sufentanil in epidural labor analgesia.
Methods A total of 257 primiparas, aged 18-40 years, BMI 18-35 kg/m2, who underwent vaginal delivery, were enrolled in this study. The parturients were randomized into 2 groups: group A (0.1% ropivacaine + sufentanyl 0.5 μg/ml, n = 129) and group B (0.15% ropivacaine, n = 128). Epidural analgesic solutions were given differently between the two groups. The visual analogue scale (VAS) before and 20 min after epidural analgesia and the maximum VAS scores were recorded. The number of patient-controlled analgesia (PCA), the number of remedial doses, the total dosage of anesthetic drugs, modified Bromage scores, satisfaction, labor time, mode of delivery, newborn’s Apgar score 1 min and 5 min after birth, and adverse reactions such as pruritus, nausea and vomiting, fever and urinary retention were also recorded.
Results The maximum VAS scores during labor and the VAS scores 20 min after epidural analgesia were significantly less than before labor analgesia in both groups (P < 0.05). But there was no significant difference between the two groups. There were no significant differences in the number of PCA, the number of remedial doses, the amount of anesthetic drugs, and satisfaction between the two groups. There were also no statistical differences in the time of labor, the mode of delivery, the Apgar scores at 1 min and 5 min after birth, and the modified Bromage scores between the two groups. Among the adverse reactions, 10 cases (7.8%) of pruritis occurred in group A, whereas no pruritis occurred in group B (P < 0.05). There were no significant differences in the incidences of nausea and vomiting, urine retention, and fetal fever between the two groups.
Conclusion The analgesic effect of 0.15% ropivacaine alone is comparable to 0.1% ropivacaine combined with sufentanil 0.5 μg/ml in epidural labor analgesia, but the pruritis occurs less with 0.15% ropivacainc alone. |
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