可行走硬膜外分娩镇痛的临床研究.docVIP

可行走硬膜外分娩镇痛的临床研究 【关键词】 硬膜外 Fang Manqing，Huang Yuguang Department of Anethesia，Maternal and Child Health Care Hospital，Nanshan District，Shenzhen518052. 【Abstract】 Objective To evaluate the safety and effectiveness of three different local anesthetics such as0.0825%ropivacaine，0.1%ropivacaine，and0.1%bupivacaine for patient-controlled walking epidural labor analˉgesia.Methods 400full term pregnancy women，ASAⅠ-Ⅱwere randomly allocated into three groups with differˉent anesthetics:group A（n=100）with0.0825%ropivacaine plus1.5μg/ml fentanyl;group B（n=100）with0.1%ropivacaine plus1.5μg/ml fentanyl;group C（n=100 ）with0.1%bupivacaine plus1.5μg/ml fentanyl;and group D（n=100）without labor analgesia as control group.The initial dose for labor analgesia was10ml in experiˉmental groups.Epidural continuous infusion rate was6-8ml/h.Patient-controlled analgesia（PCA）bolus was2ml and PCA lockout time was15minutes with electric PCA pump.Results Satisfactory analgesia was provided to the women in all three groups without side effects such as prolonged labor，assistant measures，increased C-section，and any detrimental influence on new born baby.Walking epidural analgesia was successfully achieved for women in group A and B based on the Bromage scale.Conclusion The safe and effective walking epidural analgesia could be providˉed to women during labor without severe side effects especially with drug mixture of0.0825%ropivacaine plus1.5μg/ml fentanyl. Key words epidural walking analgesia ropivacaine bupivacaine labor 理想的分娩镇痛方式应能有效减轻产妇疼痛，对母婴和宫缩无不良影响，且产妇清醒，可参与配合分娩过程。我院自2000年3月～2001年5月在300例产妇采用不同浓度的药物配方进行可行走的硬膜外分娩镇痛（walking epidural labor analgesia，简称WELA） ［1］ ，试图筛选出产妇在分娩镇痛期间不影响产程的安全有效的镇痛方法。 1 资料与方法 1.1 一般资料 选择同期初产妇400例。所有的产妇均足月妊娠，单胎头胎，ASAⅠ-Ⅱ级，胎儿情况正常。将产妇随机分成3组:A组（n=100），0.0825%罗哌卡因+芬太尼1.5μg/ml;B组（n=100），0.1%罗哌卡因+芬太尼1.5μg/ml;C组（n=100），0.1%布比卡因+芬太尼1.5μg/ml，D组未采用任何分娩镇痛药物而进入产程，自然分娩产妇作为对照组。 1.2 镇痛方法 A组、B组、和C组产妇进入活跃期且宫口开大2～3cm，按常规于L2、3间隙硬膜外穿刺，向头置管3～4cm。在A组、B组和C组病人分别经硬膜外导管注入0.0825%罗哌卡因+芬太尼1.