论文部分内容阅读
目的探讨椎管内罗哌卡因(Ropi)复合不同剂量芬太尼对腰麻与硬膜外联合分娩镇痛效果的影响。方法80例单胎足月初产妇,随机分为4组(R组含Ropi 2 mg、RF1组含Ropi 2 mg+芬太尼10μg、RF2组及RF3组均为Ropi 2 mg+芬太尼20μg,各组n=20)。所有产妇常规行L2-3硬膜外穿刺,采用腰麻与硬膜外联合阻滞技术,蛛网膜下腔注入各组不同药液2．5 ml。当产妇自觉疼痛时启动各组不同溶液的硬膜外自控镇痛,给药模式为LCP(R、RF1、RF2组均为0．1％Ropi+芬太尼1μg／ml,RF3组为0．1％Ropi+芬太尼2μg/ml)。监测妇儿情况、评估镇痛效果及不良反应。结果RF1、RF2、RF3起效时间比R组缩短(P<0．05),分别为(7．6±2．1)、(6．1±1．6)、(6．0±1．8)、(9．7±3．5)min;维持时间延长(P<0．05),分别为(62．8±6．5)、(93．0±8．2)、(98．7±10．6)、(38．5±9．7)min;硬膜外用药量R组多于其余组(P<0．05);R组3例(15％)出现下肢运动阻滞、RF1和RF2组各1例(5％),但RF2和RF3组前胸瘙痒的发生率比R组高(P<0．05),也高于RF1组,但差异无统计学意义。RF3组有1例(5％)出现胎儿心动过缓。结论蛛网膜下腔罗哌卡因2 mg复合芬太尼20μg可加快镇痛起效,维持时间明显延长;硬膜外0．1％罗哌卡因复合芬太尼1μg／ml可取得较好镇痛效果,不良反应较少。
Objective To investigate the effect of different doses of Ropi combined with spinal fentanyl on the analgesic effect of combined spinal and epidural labor. Methods Eighty primiparous single-term full-term pregnant women were randomly divided into 4 groups (Ropi 2 mg in R group, 2 mg Ropi in RF1 group and 10 μg fentanyl in RF1 group, 20 μg Ropi 2 mg + fentanyl group in RF2 group and RF3 group, n = 20). All maternal routine line L2-3 epidural puncture, spinal anesthesia and epidural block technique, subarachnoid injection of different groups of 2.5 ml. Epidural analgesia was initiated with different solutions in each group when conscious pain. The mode of administration was LCP (0.1% Ropi + fentanyl 1μg / ml for the RF1 and RF2 groups and 0.1% for the RF3 group % Ropi + fentanyl 2 μg / ml). Monitoring of women and children to assess analgesic effects and adverse reactions. Results The onset time of RF1, RF2 and RF3 were shorter than that of the R group (P <0.05), and were (7.6 ± 2.1), (6.1 ± 1.6) and (6.0 ± 1. (P <0.05), respectively, (62.8 ± 6.5), (93.0 ± 8.2), (98 ± 8) and (9.7 ± 3.5) 7 ± 10.6) and (38.5 ± 9.7) min, respectively. The amount of epidural drug in R group was more than that in the other groups (P <0.05) , And 1 case (5%) in RF1 and RF2 group. However, the incidence of prothoracic antrum in RF2 and RF3 group was higher than that in R group (P <0.05) and also higher than RF1 group, but the difference was not statistically significant. One patient (5%) in the RF3 group had a fetal bradycardia. Conclusions Subarachnoid ropivacaine 2 mg and fentanyl 20 μg can accelerate the onset of analgesia and prolong the maintenance time significantly. Epidural 0.1% ropivacaine combined with fentanyl 1 μg / ml can achieve better results Analgesic effect, less adverse reactions.