CAJ | 학술논문

目的探讨罗哌卡因与芬太尼联合硬膜外分娩镇痛的最佳浓度及对母儿的影响。方法选择自愿要求分娩镇痛的初产妇160例，随机分为四组，0.15%罗哌卡因+芬太尼(2μg/m l)(A组),0.175%罗哌卡因+芬太尼(2μg/m l)(B组),0.2%罗哌卡因+芬太尼(2μg/m l)(C组)和0.225%罗哌卡因+芬太尼(2μg/m l)（D组），以同期未实行分娩镇痛的初产妇40例为对照组（E组）。比较各组产妇分娩时镇痛效果、产程时间、剖宫产率、新生儿Apgar评分、产后出血量和麻醉不良反应等临床指标。结果阵痛强度实验组显著低于对照组，实验组中A组高于B，C和D组，但组间差异无统计学意义；观察组的第一产程活跃期时间明显短于对照组，差异有统计学意义(P<0.05)；观察组A,B和C组间第一产程活跃期时间无差异，但均显著短于D组(P<0.05)，各组产妇第二产程、第三产程时间无显著性差异(P>0.05)；观察组剖宫产率显著低于对照组，但观察组间无显著差异。各组产妇产后2h出血量、新生儿Apagar评分和麻醉不良反应无显著性差异(P>0.05)。结论0.175%~0.2%罗哌卡因与芬太尼联合自控硬膜外分娩镇痛效果好，对母婴无不良影响，值得临床进一步推广应用。
목적탐토라고잡인여분태니연합경막외분면진통적최가농도급대모인적영향。방법선택자원요구분면진통적초산부160례，수궤분위사조，0.15%라고잡인+분태니(2μg/m l)(A조),0.175%라고잡인+분태니(2μg/m l)(B조),0.2%라고잡인+분태니(2μg/m l)(C조)화0.225%라고잡인+분태니(2μg/m l)（D조），이동기미실행분면진통적초산부40례위대조조（E조）。비교각조산부분면시진통효과、산정시간、부궁산솔、신생인Apgar평분、산후출혈량화마취불량반응등림상지표。결과진통강도실험조현저저우대조조，실험조중A조고우B，C화D조，단조간차이무통계학의의；관찰조적제일산정활약기시간명현단우대조조，차이유통계학의의(P<0.05)；관찰조A,B화C조간제일산정활약기시간무차이，단균현저단우D조(P<0.05)，각조산부제이산정、제삼산정시간무현저성차이(P>0.05)；관찰조부궁산솔현저저우대조조，단관찰조간무현저차이。각조산부산후2h출혈량、신생인Apagar평분화마취불량반응무현저성차이(P>0.05)。결론0.175%~0.2%라고잡인여분태니연합자공경막외분면진통효과호，대모영무불량영향，치득림상진일보추엄응용。
Objective To test the optimum concentration of ropivacaine when combined with fentanyl in parturients undergoing labor during epidural analgesia. Methods 160 parturients undergoing labor selected for delivery with epidural analgesia were randomized into four groups: Group A (0.15% ropivacaine plus fentanyl 2 μg/mL) , Group B (0.175%ropivacaine plus fentanyl 2 μg/mL), Group C (0.2%ropivacaine plus fentanyl 2 μg/mL) and Group D (0.225%ropivacaine plus fentanyl 2 μg/mL). 40 cases as control group which were given the same treatments as that in the experimental group except painless labor. The labor pain, duration, delivery mode, visual analog scale (VAS) scores, Apgar scores, postpartum hemorrhage and maternal side-ef ects were recorded. Results Al intervention groups provided good analgesia, but group A with higher pain scores than group B, C and D. While labor duration was the same for every group in the second and third stages of labor, the intervention group experienced a relatively shorter first stage active phase and group A, B and C shorter than group D. Cesarean section rate in intervention groups were significantly lower than that in the control group (P<0.05),but there was no significant dif erence among every intervention group (P>0.05). Every group had no signi?cant dif erences with respect to rate of cesarean delivery, Apgar scores, hemorrhage of delivery, and maternal side-ef ects (P> 0.05). Conclusions 0.175 %-0.2% ropivacaine combined with fentanyl 2μg/mL epidural labor analgesia achieved the best results, had no adverse ef ect on maternal and infant, and it should be generalized in clinic.