不同浓度罗哌卡因联合芬太尼行硬膜外分娩镇痛的量效观察

摘要

Objective To investigate the optimal concentration of ropivacaine combined with fentanyl in labor epidural analgesia. Methods One hundred and twenty nul iparous women undergoing labor for delivery with epidural analgesia were randomized into four groups. Group F1 received 0.15%ropivacaine plus fentanyl 1μg/ml, group F2 0.12% ropivacaine plus fen-tanyl 1μg/ml, group F3 0.10%ropivacaine plus fentanyl 1μg/ml, group F4 0.08%ropivacaine plus fentanyl 1μg/ml. The block levels of epidural analgesia, the Bromage scores, Ramsey scores, fetal heart rate and uterine contraction in the course of labor were monitored;in addition, onset time of anesthesia, labor time, the cases with increased oxytocin use, visual analogue scale(VAS), Apgar scores of neonates and side- effect were also recorded. Results There were more cases with motor nerve block in groups F1 and F2 than those in groups F3 and F4 (P<0.05). There were more cases with increased oxytocin use in group F1 than other three groups (P<0.05). The onset of anesthesia was in group F4 was significantly longer than that in another three groups (P<0.05). The VAS scores at 30, 60 and 90min after injection in groupF4 was significantly higher than those in other three groups (P<0.05), and when drug withdraw the VAS in group F4 was significantly higher than groupF1 (P<0.05). Conclusion 0.10%ropivacaine combined with fentanyl 1μg/ml is the optimal dose with less motor block and high safety for epidural analgesia in la-bor.%目的：探讨罗哌卡因联合芬太尼行硬膜外分娩镇痛的最佳有效浓度。方法选择120例初产妇接受L2~3硬膜外穿刺置管拟行分娩镇痛，按随机数字表法分为0.15%罗哌卡因联合1μg/ml芬太尼（F1组）、0.12%罗哌卡因联合1μg/ml芬太尼（F2组）、0.10%罗哌卡因联合1μg/ml芬太尼（F3组）及0.08%罗哌卡因联合1μg/ml芬太尼（F4组）。监测镇痛过程中阻滞平面和运动阻滞发生情况、VAS、缩宫素使用增加例数等。结果 F1、F2组运动神经阻滞发生的例数多于F3、F4组（P＜0.05）。F1组缩宫素使用增加例数多于其它3组（P＜0.05）。不同罗哌卡因浓度比较，F4组起效时间最长，明显长于F1、F2、F3组（P＜0.05）。F4组给药后30、60、90min时的VAS明显高于F1、F2、F3组，停药时的VAS明显高于F1组（P＜0.05）。F4组镇痛后30min内第3次宫缩开始每次宫缩对应的VAS明显高于F1、F2、F3组（P＜0.05）。结论罗哌卡因联合1μg/ml芬太尼用于分娩镇痛时，0.10%是最佳有效浓度，镇痛效果好，运动阻滞轻，安全性高。