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目的 探索分娩期硬膜外腔用药镇痛的镇痛效果和安全性。方法 60例ASAⅠ～Ⅱ级单胎足月初产妇 ,前瞻随机分为 4组 :RⅠ组 :硬膜外 0 12 5 %罗哌卡因组 (n =15 )、RⅡ组 :硬膜外 0 2 %罗哌卡因组 (n =15 )、B组 :硬膜外0 12 5 %布比卡因组加芬太尼 2 μg/ml(n =15 )与C组 :空白对照组 (n =15 )。RⅠ组、RⅡ、B组在宫口张开 3cm时 ,经L2 -3置入硬外导管行分娩镇痛 ,采用首量 +持续背景剂量 +PCA模式给药 ,分别为 :首量 5ml,持续注射剂量 3～ 6ml/h ,PCA 3ml/次 ,C组为产科常规处理。临床观察 4组产妇的生命体征、镇痛评分、产程、下肢运动评分、催产素用量、器械助产分娩率和新生儿Apgar评分。结果 4组产妇生命体征稳定。RⅠ组、RⅡ组与B组均取得良好镇痛效果。与C组相比 ,RⅡ ,B组的器械助产率增加明显 (P <0 0 5 ) ,RⅠ组无差异。 4组间剖宫产率无明显差异。RⅡ ,B组的第二产程延长 16 1% ,18 3 % ,RⅠ组无产程延长。新生儿出生Apgar评分 4组无差异。结论 硬膜外镇痛分娩具有镇痛效果好、副作用少的特点 ,是目前最常用的方法。镇痛组均有良好的镇痛效果。 0 12 5 %布比卡因复合芬太尼 ( 2 μg/ml)会使第二产程延长 ,器械助产率增加
Objective To explore the analgesic effect and safety of epidural analgesia during labor. Methods Sixty primiparous term term singleton fetuses of ASA Ⅰ ~ Ⅱ were randomly divided into 4 groups: RⅠgroup: 0,125% epidural ropivacaine group (n = 15), R Ⅱ group: epidural 0 2% Group B: epidural 0,125% bupivacaine plus fentanyl 2 μg / ml (n = 15) and group C: blank control group (n = 15) ). RⅠgroup, RⅡ, B group were given labor analgesia via L2-3 in the cervix when the cervix was open 3cm, and were administered with the first dose + continuous background dose + PCA mode, respectively: the first volume of 5ml, sustained Injection dose 3 ~ 6ml / h, PCA 3ml / times, C group for routine obstetric treatment. The clinical signs, analgesia scores, labor process, lower extremity motion score, oxytocin dosage, midwifery delivery rate and neonatal Apgar score were observed. Results The 4 groups of maternal vital signs were stable. R Ⅰ group, R Ⅱ group and B group have achieved good analgesic effect. Compared with the C group, RII, B group of device midwifery rate increased significantly (P <0 05), R I group no difference. Cesarean section rate between the 4 groups no significant difference. The second stage of labor in RⅡ and B group was prolonged by 16 1% and 18 3%, and prolonged labor-free stage in RⅠ group. Neonatal Apgar score 4 groups no difference. Conclusion Epidural analgesia with analgesic effect is good, less side effects, is the most commonly used method. Analgesia group has a good analgesic effect. 0,12 5% bupivacaine combined with fentanyl (2 μg / ml) will prolong the second stage of labor, equipment, birth rate increased