【摘要】 目的　评价罗哌卡因复合芬太尼用于产妇自控硬膜外镇痛的可行性。方法　ASAⅠ～Ⅱ级初产妇足月单胎 90例随机分为 3组。 30例为对照组 ,6 0例分为 2组镇痛组 :A组 (PCEA LP)0 .2 %罗哌卡因复合芬太尼 2 μg ml负荷量 10ml,当VAS≥ 2 0mm时 ,自控给药 4ml 次 ,锁定时间为15min。B组 (PCEA LCP)相同药物负荷量 10ml,半小时后背景量 4ml h ,当VAS≥ 2 0mm给药 4ml 次 ,锁定时间为 15min ,直到宫口开全停药。连续监测呼吸循环状况 ,评估镇痛效应和运动阻滞的程度 ,观察记录产程进展 ,采集静脉血测血浆儿茶酚胺浓度 ,观察不良反应及新生儿情况。结果　新生儿评分 ,脐带静脉血血气分析 ,活跃期及第Ⅱ产程时间 3组无显著差异。A、B两组间VAS疼痛评分 ,感觉阻滞 ,运动阻滞程度 ,NE ,E浓度和剖宫产率无差别。对照组剖宫产率显著高于镇痛组 (P <0 .0 1) ,第一产程末NE、E浓度显著高于镇痛组 (P <0 .0 1)。A组用药量、瘙痒发生率低及胎头吸引率均低于B组 (P <0 .0 1)。结论　 0 .2 %罗哌卡因复合芬太尼 2 μg ml硬膜外自控镇痛安全有效 ,降低了剖宫产率 ,在相同的分娩镇痛水平PCEA LP模式比PCEA LCP模式用药更少 ,副作用发生率低更多还原

【Abstract】 Objective To compare two methods of patient controlled epidural analgesia (PCEA) with 0 2% ropivacaine plus fentanyl 2μg·ml -1 with or without background infusion for labor Methods Ninety ASA Ⅰ Ⅱ full term primigravidae in active labor who had a single fetus with vertex presentation and were expected to have vaginal delivery were randomly divided into three groups of 30 each: group A received PCEA without background infusion; group B received PCEA with background infusion and group C received no analgesia of any kind and served as control PCEA included a bolus of 4 ml with a 15 minute lock out When the primigravida was in first stage of labor, an intravenous line was established and 5% glucose normal saline 500 1000 ml was being infused When the external cervical os was dilated to 3 cm, epidural catheter was placed at L 2 3 and a test dose of 4 ml was given 5 min later when no signs of subarachnoid injection was evident, block height was tested by pinprick and another 6 ml was given 30 min later in group B background infusion of 0 2% ropivacaine + fentanyl 2μg·ml -1 was started at a rate of 4 ml·h -1 until the second stage of labor began Maternal vital signs (BP, ECG, SpO 2, P ET CO 2), VAS scores, degree of motor block, drug consumption, side effects of PCEA, gas analysis of umbilical venous blood, progress of labor, and Apgar scores were noted Venous blood samples were taken before PCEA and at the end of first stage of labor for determination of serum epinephrine and norepinephrine levels Results There were no significant differences in Apgar scores, blood gas of umbilical venous blood and the durations of first and second stage of labor among the three groups There were no differences in VAS scores, degree of sensory and motor block, serum concentrations of epinephrine and norepinephrine and percentage of cesarean section between group A and B The percentage of cesarean section was significantly higher in control group than that in group A and B Plasma NE and E concentrations at the end of the first stage of labor were significantly higher in control group than those in group A and B The ropivacaine and fentanyl consumption was less and the incidence of itching and percentage of instrumental delivery were lower in group A than those in group B Conclusions PCEA with 0 2% ropivacaine and fentanyl 2μg·ml -1 was safe and effective It reduces the percentage of cesarean section PCEA without background infusion provides the same level of analgesia as PCEA with background infusion with less drugs and side effects更多还原