国际医药卫生导报
國際醫藥衛生導報
국제의약위생도보
INTERNATIONAL MEDICINE & HEALTH GUIDANCE NEWS
2014年
17期
2671-2674
,共4页
袁庆明%周传华%莫洁平%梁鉴华%曾馨文
袁慶明%週傳華%莫潔平%樑鑒華%曾馨文
원경명%주전화%막길평%량감화%증형문
罗哌卡因%芬太尼%自控硬膜外镇痛%可行走性分娩镇痛
囉哌卡因%芬太尼%自控硬膜外鎮痛%可行走性分娩鎮痛
라고잡인%분태니%자공경막외진통%가행주성분면진통
Ropivacaine%Fentanyl%Patient controlled epidural analgesia%Walking labor analgesia
目的 比较不同浓度罗哌卡因复合芬太尼持续输注在可行走性分娩镇痛中产妇BP、HR、SpO2、产程、胎心、宫缩的变化及缩宫素使用率及对视觉模拟评分(VAS)及产妇运动神经阻滞的影响.方法 选择自愿要求行分娩镇痛的初产妇180例,采用不同浓度罗哌卡因行PCEA,并与同时未行镇痛的产妇进行比较,随机分为A、B、C组各60例,三组产妇经硬膜外腔分别注入0.075％罗哌卡因+芬太尼2.0μg/ml、0.125％罗哌卡因+芬太尼2.0μg/ml、0.20％罗哌卡因+芬太尼2.0μg/ml,于宫口开至2～3cm时,L2-3硬膜外穿刺向头端置管,注0.8％利多卡因,5 min后给负荷量8～ 10ml镇痛液,确定镇痛平面,疼痛明显减轻后接镇痛泵.持续输注药液6～8ml,单次按压量3 ml,间隔时间15 min,宫口开全停药.结果 三组产妇可行走性分娩镇痛后各时间点VAS评分均显著降低,差异有统计学意义(P＜0.05);实施可行走性分娩镇痛后A、B组运动神经阻滞,在0级、1级、2级出现的例数与C组比较差异有统计学意义(P＜0.05),再追加局麻复合液三组比较差异无统计学意义(P＞0.05);三组产妇分娩方式及缩宫素使用情况及新生儿Apgar评分比较差异无统计学意义(P＞0.05).结论 0.125％罗哌卡因+芬太尼2.0μg/ml持续输注用于可行走性分娩镇痛时镇痛效果好,运动神经阻滞轻,值得临床推广.
目的 比較不同濃度囉哌卡因複閤芬太尼持續輸註在可行走性分娩鎮痛中產婦BP、HR、SpO2、產程、胎心、宮縮的變化及縮宮素使用率及對視覺模擬評分(VAS)及產婦運動神經阻滯的影響.方法 選擇自願要求行分娩鎮痛的初產婦180例,採用不同濃度囉哌卡因行PCEA,併與同時未行鎮痛的產婦進行比較,隨機分為A、B、C組各60例,三組產婦經硬膜外腔分彆註入0.075％囉哌卡因+芬太尼2.0μg/ml、0.125％囉哌卡因+芬太尼2.0μg/ml、0.20％囉哌卡因+芬太尼2.0μg/ml,于宮口開至2～3cm時,L2-3硬膜外穿刺嚮頭耑置管,註0.8％利多卡因,5 min後給負荷量8～ 10ml鎮痛液,確定鎮痛平麵,疼痛明顯減輕後接鎮痛泵.持續輸註藥液6～8ml,單次按壓量3 ml,間隔時間15 min,宮口開全停藥.結果 三組產婦可行走性分娩鎮痛後各時間點VAS評分均顯著降低,差異有統計學意義(P＜0.05);實施可行走性分娩鎮痛後A、B組運動神經阻滯,在0級、1級、2級齣現的例數與C組比較差異有統計學意義(P＜0.05),再追加跼痳複閤液三組比較差異無統計學意義(P＞0.05);三組產婦分娩方式及縮宮素使用情況及新生兒Apgar評分比較差異無統計學意義(P＞0.05).結論 0.125％囉哌卡因+芬太尼2.0μg/ml持續輸註用于可行走性分娩鎮痛時鎮痛效果好,運動神經阻滯輕,值得臨床推廣.
목적 비교불동농도라고잡인복합분태니지속수주재가행주성분면진통중산부BP、HR、SpO2、산정、태심、궁축적변화급축궁소사용솔급대시각모의평분(VAS)급산부운동신경조체적영향.방법 선택자원요구행분면진통적초산부180례,채용불동농도라고잡인행PCEA,병여동시미행진통적산부진행비교,수궤분위A、B、C조각60례,삼조산부경경막외강분별주입0.075％라고잡인+분태니2.0μg/ml、0.125％라고잡인+분태니2.0μg/ml、0.20％라고잡인+분태니2.0μg/ml,우궁구개지2～3cm시,L2-3경막외천자향두단치관,주0.8％리다잡인,5 min후급부하량8～ 10ml진통액,학정진통평면,동통명현감경후접진통빙.지속수주약액6～8ml,단차안압량3 ml,간격시간15 min,궁구개전정약.결과 삼조산부가행주성분면진통후각시간점VAS평분균현저강저,차이유통계학의의(P＜0.05);실시가행주성분면진통후A、B조운동신경조체,재0급、1급、2급출현적례수여C조비교차이유통계학의의(P＜0.05),재추가국마복합액삼조비교차이무통계학의의(P＞0.05);삼조산부분면방식급축궁소사용정황급신생인Apgar평분비교차이무통계학의의(P＞0.05).결론 0.125％라고잡인+분태니2.0μg/ml지속수주용우가행주성분면진통시진통효과호,운동신경조체경,치득림상추엄.
Objective To compare the different concentrations of ropivacaine combined with fentanyl infusion analgesia labor in walking labor analgesia in maternal BP,HR,SpO2,labor,fetal heart,uterine contractions and oxytocin usage and the visual analogue scale (VAS) and maternal motor nerve block.Methods 180 cases of primipara volunteered for labor analgesia,ropivacaine with different concentration of patient controlled epidural analgesia (PCEA),and compared with parturients without analgesia,were randomly divided into group A,group B and group C with 60 cases in each group,three groups were respectively injected into the epidural 0.075％ ropivacaine and fentanyl 2 μ g/ml (group A,n=60),0.125％ ropivacaine plus fentanyl 2 μ g/ml (group B,n=60),0.20％ ropivacaine and fentanyl 2 μ g/ml (group C,n=60).With the cervix opening to the 2-3 cm,L2-3 epidural cephalad catheter,injection of 0.8％ lidocaine,5 mins to the load of 8-10 resistant analgesic liquid,confirming the analgesic plane,pain significantly reduced with analgesia pump.Continuous infusion of 6-8 ml,a single push volume of 3 ml,interval time of 15 min,wide open withdrawal.Results The results of three groups of maternal analgesia labor walk at each time point after VAS score was significantly lower with significant difference (P ＜ 0.05); feasible implementation of labor analgesia in group A,group B motor nerve block,in class 0,grade 1,2 cases of group C,and the difference was statistically significant (P ＜ 0.05);additional anesthesia compound liquid of three groups had no significant difference (P ＞ 0.05); there was no significant difference between three groups of maternal mode of delivery and use of oxytocin and neonatal Apgar score (P ＞ 0.05).Conclusion 0.125％ ropivacaine + fentanyl was 2 μg/ml continuous infusion for labor analgesia when walk good analgesic effect,motor nerve block light,is worth the clinical promotion.
