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目的 :研究 0 12 5 %布比卡因和罗哌卡因用于硬膜外自控分娩镇痛对母婴肾素 -血管紧张素 -醛固酮系统 (RAAS)的影响。方法 :90例ASAⅠ级健康初产妇随机分为 3组 ,每组 3 0例。A组行PCEA ,采用 0 12 5 %布比卡因 + 2 μg/mL芬太尼 ;B组行PCEA ,采用 0 12 5 %罗哌卡因 + 2 μg/mL芬太尼 ;C组 (对照组 )为自然分娩、顺产产妇。分别于宫口开至 2～ 3cm镇痛前 (T0 )、宫口开至 3～ 4cm (T1)、宫口开全时 (T2 )、胎儿娩出后即刻 (T3 )、产后2 4h(T4)抽取母体肘静脉血和胎儿娩出后即刻胎儿脐动、静脉血测定血清肾素活性 (PRA )、血管紧张素Ⅱ (AT Ⅱ )和醛固酮 (ALD)浓度 ;评定镇痛效果 ,记录两组宫口开大 2～ 3cm至胎儿娩出的时间及新生儿娩出 1min、5min的Apgar评分。结果 :3组HR、SpO2 、BP、RR变化及新生儿 1min、5min时的Apgar评分差异均无显著性 (P >0 0 5 ) ;3组宫口开大 2～ 3cm至胎儿娩出的时间比较 :C组 >A组 >B组 (P <0 0 5 ) ;A、B组于T1、T2 、T4的母体PRA、AT Ⅱ、ALD值均比T0 、T3 明显降低 (P <0 0 1) ,胎儿脐动、静脉血的PRA、AT Ⅱ、ALD值A、B组差异不明显 ,但三者也明显低于母体T0 、T3 值 (P <0 0 1) ;相反C组于T0 、T1、T2 、T3 的母体及胎儿脐动、静脉血的PRA、AT Ⅱ、ALD值均比T
OBJECTIVE: To investigate the effect of 0,125% bupivacaine and ropivacaine on maternal-neonatal renin-angiotensin-aldosterone system (RAAS) for epidural controlled labor analgesia. Methods: Ninety ASA I-stage primiparous women were randomly divided into 3 groups, 30 cases in each group. Group A received PCEA with 0,125% bupivacaine plus 2 μg / mL fentanyl; Group B received PCEA with 0,125% ropivacaine plus 2 μg / mL fentanyl; Group C (control Group) for natural childbirth, cesarean section. (T0), cervix to 3 ~ 4cm (T1), cervix to open the whole time (T2), fetus immediately after delivery (T3), postpartum 24h (T4) The maternal elbow venous blood and fetal umbilical artery and venous blood samples were collected for the determination of serum renin activity (PRA), angiotensin Ⅱ (AT Ⅱ) and aldosterone (ALD) concentrations. The analgesic effects were evaluated. Open large 2 ~ 3cm to the time of delivery of the fetus and neonates delivered 1min, 5min Apgar score. Results: The changes of HR, SpO2, BP and RR in 3 groups were not significantly different from those in 1 and 5 min neonates (P> 0.05). The time of 3 ~ (P <0.01). The levels of PRA, AT Ⅱ and ALD in group A and B at T1, T2 and T4 were significantly lower than those at T0 and T3 (P <0.01) (P <0.01). In the contrary group C, there was no significant difference in PRA, AT Ⅱ and ALD between groups A and B, but the three groups were also significantly lower than those of T0 and T1 , T2, T3, maternal and fetal umbilical artery, venous blood PRA, AT Ⅱ, ALD values than T