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目的 :比较 0 12 5 %及 0 2 %罗比卡因与 0 12 5 %布比卡因在病人自控硬膜外镇痛 (PCEA)分娩镇痛中应用的临床效果。方法 :90例ASAⅠ～Ⅱ级足月初产妇 ,随机分为三组。A组采用 0 12 5 %罗比卡因 (n =30 ) ;B组采用0 2 %罗比卡因 (n =30 ) ;C组采用 0 12 5 %布比卡因 (n =30 )。三组均加入芬太尼 2 μg/ml。首剂负荷量给予 10ml。采用电子镇痛泵调节持续量为 5ml/h ,单次按压量每次 2ml,锁定时间 15分钟。于宫口开至 8～ 9cm时再给药 10ml,宫口开全后停用麻醉药。结果 :三组均能提供安全有效的分娩镇痛 ,产程时间无延长 ,阴道助产率无增加 ,剖宫产率显著下降 ,对胎儿、新生儿无不良影响。两组罗比卡因与布比卡因组比较 ,缩短产程时间明显 ,催产素使用率及阴道器械助产率无增加 ,对产妇下肢活动影响小。结论 :与 0 12 5 %布比卡因相比 0 12 5 %或 0 2 %罗比卡因 (均与 2 μg/ml芬太尼合用 )在PCEA分娩镇痛中 ,感觉和运动阻滞明显分离 ,对分娩的影响更小 ,更适用于分娩镇痛。
OBJECTIVE: To compare the clinical effects of 0,125% and 0,2% ropivacaine with 0,125% bupivacaine in pain relief in patient-controlled epidural analgesia (PCEA). Methods: Ninety ASA Ⅰ ~ Ⅱ full term primipara were randomly divided into three groups. Group A received 0,125% ropivacaine (n = 30); Group B received 0,2% ropivacaine (n = 30); Group C used 0,125% bupivacaine (n = 30). Fentanyl 2 μg / ml was added to all three groups. The first dose to give 10ml. The use of electronic analgesia pump to adjust the sustained volume of 5ml / h, a single press each 2ml, lock time 15 minutes. In the cervix to open when 8 ~ 9cm and then given 10ml, stop after opening the cervix anesthesia. Results: All the three groups could provide safe and effective labor analgesia, no prolonged labor duration, no increase of vaginal delivery rate, a significant decline of cesarean section rate and no adverse effects on fetus and newborn. Two groups of ropivacaine and bupivacaine group, shorten the time of labor significantly, oxytocin use rate and vaginal device did not increase the rate of midwifery, maternal lower limb activity. CONCLUSIONS: Compared with 0,125% bupivacaine, 0,125% or 0,2% ropivacaine (both in combination with 2 μg / ml fentanyl) had a significant sensory and motor block during labor analgesia in PCEA Separation, the impact of childbirth is smaller, more suitable for labor analgesia.