摘要
目的 :比较不同剂量罗哌卡因 (Rop)蛛网膜下腔注射复合硬膜外病人自控镇痛 (PCEA)进行分娩镇痛的效果及对产程的影响。方法 :12 0例单胎足月的自愿初产妇随机分为Ⅰ～Ⅵ组 ,每组 2 0例 ,分别蛛网膜下腔注入 :Ⅰ组Rop2 .0mg、Ⅱ组Rop 2 .5mg、Ⅲ组Rop 3.5mg、Ⅳ组Rop 5 .0mg、Ⅴ组Rop 2 .0mg +芬太尼 2 0 μg、Ⅵ组芬太尼 2 0 μg。六组均于L2～ 3 腰穿注药后留置硬膜外导管行PCEA ,硬膜外腔采用 0 .1%Rop与 2 .0 μg/mL芬太尼混合液持续输注 5mL/h ,自控镇痛每次给药 3mL ,锁定时间 10min。结果 :Ⅰ组～Ⅳ组镇痛起效时间平均 (5 .9± 1.5 )min。Ⅴ组平均 (2 .0± 1.5 )min ,比其他组起效较快 (P <0 .0 5 ) ,Ⅵ组平均 (6 .2± 1.8)min。六组蛛网膜下腔注药起效稳定后阻滞平面T9～ 11。各组蛛网膜下腔给药后阻滞平面与PCEA 1h后的阻滞平面比较未见明显变化。六组镇痛效果均达到满意程度 ,各组视觉模拟镇痛 (VAS)评分 :随着蛛网膜下腔注射Rop剂量增加 ,VAS评分值有减少趋势 (P >0 .0 5 )。各组Bromage运动评分 :以Ⅳ组分值较高 ,其运动阻滞程度较为显著 (P <0 .0 5 ) ;各组对产程、产后出血量、胎儿Apgar评分、器械助产率、剖宫产率的影响差异无显著性 (P >0 .0 5 ) 。
Objective:To compare the analgesic efficacy and influence on labor stages of different dosage of ropivacaine(Rop) administered subarachnoidly. Method:One hundred and twenty full term singleton primipara were randomly divided into 6 groups( n =20)double blindly. Group Ⅰ,Ⅱ,Ⅲ,and Ⅳ were injected subarachnoidly with Rop 2 0 mg,2.5 mg,3.5 mg,and 5.0 mg respectively,group V, Rop 2.0 mg + fentanyl 20 μg,and group VI, fentanyl 20 μg. Patient controlled epidural analgesia (PCEA) with 0.1% ropivacaine +2.0 μg/mL fentanyl, 5 mL/h continuous infusion with PCA bolus 3 mL,lockout time 10 min,was performed. Result:The onset time of group Ⅰ ～ Ⅳ was (5.9±1.5) min,which was significantly longer than that in group Ⅴ (2.0±1.5)min ( P <0.05). The analgesic efficacy was all satisfactory in the six groups. With the quantities of the Rop increase,the visual analogy score (VAS) was degressive and Bromage movement recovery: score in group Ⅳ was higher,but the extent of retardation of movement was significant( P <0.05). There was no statistical difference among six groups in labor stages, postpartum hemorrhage,Apgar scores,frequency of forceps delivery,use of cesarean section,but in group Ⅳ,the frequency of oxytocin dosing was significantly higher than that in the other groups ( P <0.5～0.01). Pruritus occurred more often in group Ⅴ and VI than that in the other groups ( P <0.05). Conclusion:Rop 2.5～5.0 mg administered subarachnoidly for labor analgesia is safe and effective,with no obvious adverse effect on mother and child. Ropivacaine combined with fentanyl has a synergic effect,shortens onset time,reduces the dose of ropivacaine and has less movement blockade. Single dose of 20 μg fentanyl produces a satisfactory analgesia,no movement blockade,but more pruritus. After subarachnoid ropivacaine,PCEA can maintain a longtime analgesia.
出处
《广州医学院学报》
2002年第4期14-17,共4页
Academic Journal of Guangzhou Medical College
基金
广东省医学科学研究基金资助课题 (粤卫A19994 97)
广州医学院科研项目 (学院 1992 5 )
