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目的观察产妇产程潜伏期和活跃期罗哌卡因混合舒芬太尼硬膜外分娩镇痛的效应, 评价潜伏期镇痛的可行性。方法 120例无产科及硬膜外阻滞禁忌症的单胎孕初产妇,随机分为2 组。潜伏期组(L组):当进入产程、但宫口<3 cm进行镇痛;活跃期组(A组):当宫口≥3 cm进行镇痛。硬膜外穿刺成功后,两组分别单次给予0．1％、O．15％罗哌卡因与O．5μg/ml 舒芬太尼混合液10- 15 ml。30 min后行硬膜外自控镇痛,药物为0．1％罗哌卡因和0．5 μg/ml舒芬太尼的混合液,PCA量6 ml,锁定时间20 min(L组)、15 min(A组)。行VAS评分和运动神经阻滞分级,记录产后产妇的不良反应,对新生儿行Apgar评分。结果两组镇痛后VAS评分均降低,与A组比较,L组镇痛前VAS评分降低,镇痛后20、30 min VAS评分升高,下肢麻木发生率升高,镇痛前催产素使用率及镇痛后催产素追加率降低(P<0．05)。两组产程、剖宫产率和器械助产率及镇痛满意度的优良率差异无统计学意义 (均超过95％)(P>0．05)。结论产妇产程潜伏期0．1％罗哌卡因混合O．5μg/ml舒芬太尼硬膜外分娩镇痛安全、有效。
Objective To observe the effect of epidural analgesia induced by ropivacaine mixed with ropivacaine in incubation period and active phase of maternal labor to evaluate the feasibility of latent analgesia. Methods A total of 120 primiparous women with obstetrics and epidural block contraindications were randomly divided into two groups. Latent group (L group): when entering the labor process, but the cervix <3 cm for analgesia; active group (group A): when the cervix ≥ 3 cm for analgesia. After successful epidural puncture, both groups were given a single 0.1%, O. 15% ropivacaine and O. 5μg / ml sufentanil mixture 10-15ml. Epidural analgesia was given after 30 min. The drug was 0.1% ropivacaine and 0.5 μg / ml sufentanil. The amount of PCA was 6 ml and the locking time was 20 min (group L) 15 min (group A). VAS score and motor nerve block grading, record postpartum maternal adverse reactions, neonatal Apgar score. Results The VAS score decreased after analgesia in both groups. Compared with the A group, the VAS score decreased before the analgesia in group L, the VAS score increased at 20 and 30 min after analgesia, the incidence of numbness in lower limb increased, Rates and analgesic oxytocin recovery rate decreased (P <0.05). There was no significant difference in the rate of labor, cesarean section rate, device birth rate and satisfaction rate of analgesia (all more than 95%) (P> 0.05). Conclusion The incubation period of maternal labor is 0.1% ropivacaine mixed. Sufentanil 5μg / ml epidural analgesia safe and effective.