罗哌卡因及芬太尼持续硬膜外自控镇痛用于无痛分娩96例.docVIP

罗哌卡因及芬太尼持续硬膜外自控镇痛用于无痛分娩96例【摘要】 目的 探讨罗哌卡因与芬太尼持续硬膜外自控镇痛用于无痛分娩的效果及对母婴状况的影响。方?法 ?将要求阴道分娩且无产科禁忌证的初产妇192例分为两组，其中做无痛分娩而无麻醉禁忌证的产妇96例，用0.125%罗哌卡因与2 μg/ml芬太尼混合液做持续硬膜外自控镇痛（Ⅰ组）与拒绝分娩镇痛的产妇96例（Ⅱ组）进行比较，观察镇痛效果，胎心情况，不良反应，分娩方式，胎儿宫内窘迫及新生儿窒息情况。结果 分娩镇痛效果好，未见明显不良反应，显著降低了剖宫产率，但胎儿宫内窘迫及新生儿窒息情况与Ⅱ组比较差异无统计学意义。结论 罗哌卡因与芬太尼持续硬膜外自控镇痛用于无痛分娩镇痛效果确切，母婴健康状况未受影响。? 【关键词】 持续硬膜外自控镇痛； 产科； 罗哌卡因； 芬太尼?? Ropivacaine and fentanyl for patient-controlled epidural analgesia for painless labor in 96 cases ?MA Jun. WuHuan University of Science and Technology, Wuhan 430050, China?? 【Abstract】 Objective To investigate the efficacy and safety of ropivacaine combined with fentanyl for patient-controlled epidural analgesia in painless labor.Methods 192 primigravidae were divided into two groups of 96 each. Group 1 who required painless childbirth without anesthesia contraindications received with 0.125% ropivacaine combined with fentanyl mixed 2 μg/ml dose continuous epidural analgesia liquid. Group 2 received no analgesia and served as control. The vital signs, fetal heart rate adverse reactions, mode of delivery, fetal distress and neonatal asphyxia were recorded.Results The effectiveness of group 1 for analgesia labor was confirmed, the rate of caesarean section of group 1 was much lower than group 2, the rate of anoxia of newborn of 2 groups revealed no significant difference.Conclusion Ropivacaine combined with fentanyl is suitable for patient-controlled epidural analgesia in painless labor.? 【Key words】 Patient-controlled epidural analgesia; Obstetrical; Ropivacaine; Fentanyl ?? 一个半世纪以来，分娩时的剧烈疼痛长期困扰着产妇，使部分产妇因畏惧疼痛而放弃阴道分娩，还有部分产妇因疼痛而强烈要求剖宫产。无痛分娩，让产妇在清醒无痛苦状态下分娩，诞生新生命，是产妇、家属及社会各界人士的共同心愿。为了使医疗服务更人性化，最近几年笔者所在医院采用低浓度罗哌卡因与芬太尼持续硬膜外自控镇痛用于无痛分娩，并与非镇痛自然分娩进行比较，取得满意效果，现将观察结果分析如下。? 1 资料与方法? 1.1 一般资料 住院待产足月初产妇共192例，其中要求无痛分娩，且无禁忌证者96例（Ⅰ组），与同期非镇痛自然分娩96例初产妇（Ⅱ组）进行比较分析，两组产妇的年龄、孕周、身高等方面差异无统计学意义。? 1.2 方法 Ⅰ组：当孕妇规律宫缩开始，宫口开大3 cm后，选择L?2～L?3间隙常规硬膜外穿刺置管，成功后选择1%利多卡因5 ml为试验量，5 min后试麻醉平面，若麻醉平面在T??10?以下，下肢活动自如，孕妇的血压、脉搏、呼吸稳定，