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目的 :观察不同浓度罗哌卡因 (ropivacaine ,Rop)用于分娩镇痛的临床效果 ,探索其理想的浓度和剂量。方法 :随机选择ASAⅠ～Ⅱ级临产初产妇 45例 ,平均分为三组 :0 .16 %Rop组和 0 .2 %Rop组作为观察组 ,以及对照组 15例。观察组于宫口开至 2～ 3cm时于L2～ 3 间隙行硬膜外腔穿刺置管 ,以罗哌卡因维持镇痛 ;对照组未作分娩镇痛。围分娩镇痛期连续监测血压 (BP)、脉氧饱和度 (SpO2 )、EKG、PETCO2 、宫缩及胎心音 ,记录产程时间 ;镇痛效果采用VAPS评分法进行疼痛评分 ,运动神经阻滞以Bromage分级评分 ;新生儿出生后 1～ 5min进行Apgar评分 ,分娩后 2 4h新生儿NACS评分。结果 :围分娩期三组生命体征稳定 ;VAPS评分观察组较对照组明显降低 ,但 0 .2 %Rop对运动神经的阻滞频率和程度最重 ,对宫缩有轻微的抑制 ,催产素用量相对增加 ;对产程的影响均短于对照组 ,但差异不显著 ;三组对围分娩期胎心、Apgar评分无影响 ;分娩后 2 4hNACS评分观察组较对照组增高明显 ;剖宫产率 0 .16 % ,Rop组最低。结论 :罗哌卡因独特的感觉和运动阻滞明显分离 ,对子宫胎盘血流无明显影响 ,有利于分娩镇痛。 0 .2 %Rop较 0 .16 %对运动神经阻滞的频率和程度更重 ,0 .16 %Rop对于分娩镇痛是一种比较理想的局部麻醉药
Objective: To observe the clinical effect of different concentrations of ropivacaine (Rop) on labor analgesia and to explore its ideal concentration and dosage. Methods: Forty-five cases of ASA Ⅰ ~ Ⅱ primiparae were randomly divided into three groups: 0.16% Rop group and 0.2% Rop group as observation group and 15 cases as control group. Observation group in the cervix to 2 ~ 3cm at L2 ~ 3 space epidural catheter, to maintain analgesia with ropivacaine; control group did not make labor analgesia. The blood pressure (BP), SpO2, EKG, PETCO2, contractions and fetal heart sounds were recorded continuously during labor analgesia. The analgesic effect was recorded by VAPS score and the motor nerve block Bromage grading; Neonatal Apgar score 1 ~ 5min after birth, neonatal 24 h after delivery NACS score. Results: The vital signs in the three groups during delivery were stable. The VAPS score in the observation group was significantly lower than that in the control group. However, 0.2% Rop had the most frequent block of the motor nerve and slight inhibition of uterine contraction. The oxytocin dosage But the difference was not significant. The three groups had no effect on the fetal heart rate and Apgar score at 24 hours after delivery, and the NACS score at 24 hours after delivery increased significantly compared with the control group. The rate of cesarean section was 0 .16%, lowest in Rop group. Conclusion: The unique sensory and motor block of ropivacaine is obviously separated and has no obvious effect on uterine placental blood flow, which is good for labor analgesia. 0 .2% Rop vs. .16% had a greater frequency and degree of motor block, with 0.16% Rop being an ideal local anesthetic for labor analgesia