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目的:探讨布比卡因与罗哌卡因硬膜外自控分娩镇痛临床效果差异及对新生儿脐血管血气分析指标的影响。方法:选取我院产科2012年1月至2013年12月硬膜外自控分娩镇痛的产妇150例,以随机数字表法分为A组(75例)和B组(75例),分别给予布比卡因+芬太尼或罗哌卡因+芬太尼复合麻醉镇痛,比较两组镇痛前后视觉模拟评分法(VAS)、第一和第二产程时间、宫缩持续时间、胎儿娩出后产妇改良Bromage评分、新生儿娩出后5 min Apgar评分及脐血管血气分析指标。结果:A组患者镇痛前、镇痛后5 min、10 min、15 min及20 min VAS评分分别为(9.33±2.93)分、(4.56±1.18)分、(3.21±0.95)分、(2.63±0.77)分、(1.17±0.45)分;B组患者镇痛前、镇痛后5 min、10 min、15 min及20 min VAS评分分别为(9.40±2.98)分、(4.50±1.14)分、(3.17±0.93)分、(2.57±0.74)分、(1.12±0.43)分;两组产妇镇痛后VAS疼痛评分均显著优于镇痛前,差异有统计学意义(P<0.05);两组产妇镇痛后不同时间点VAS疼痛评分组间比较差异无统计学意义(P>0.05)。A组产妇第一、二产程时间及宫缩持续时间分别为(413.25±50.82)min、(52.66±15.90)min、(0.37±0.12)min;B组产妇第一、二产程时间及宫缩持续时间分别为(406.89±49.98)min、(50.81±15.73)min、(0.34±0.11)min;两组产妇第一、第二产程时间及宫缩持续时间比较差异无统计学意义(P>0.05)。两组胎儿娩出后产妇改良Bromage评分和新生儿娩出后5 min Apgar评分比较差异无统计学意义(P>0.05)。两组胎儿娩出后脐动脉和脐静脉血气分析指标组内比较差异无统计学意义(P>0.05),组间比较差异有统计学意义(P<0.05),但均在正常范围内。结论:布比卡因与罗哌卡因均可有效用于硬膜外自控分娩镇痛,且对新生儿脐血管血气分析指标无明显影响。
OBJECTIVE: To investigate the difference of clinical efficacy of epidural analgesia between bupivacaine and ropivacaine and the influence of neonatal umbilical blood gas analysis index. Methods: 150 cases of epidural labor-controlled labor analgesia in our hospital from January 2012 to December 2013 were randomly divided into group A (75 cases) and group B (75 cases) by random number table Bupivacaine + fentanyl or ropivacaine + fentanyl. The visual analogue scale (VAS), time of first and second stage of labor, duration of uterine contractions, fetus Maternal improvement Bromage score after delivery, Apgar score at 5 min after delivery and umbilical blood gas analysis index. Results: The VAS scores of group A were (9.33 ± 2.93) points, (4.56 ± 1.18) points, (3.21 ± 0.95) points and (2.63) points respectively before analgesia, 5 minutes, 10 minutes, 15 minutes and 20 minutes after analgesia. ± 0.77) and (1.17 ± 0.45) points respectively. The VAS score of group B before treatment, 5 min, 10 min, 15 min and 20 min after analgesia were (9.40 ± 2.98) and (4.50 ± 1.14) , (3.17 ± 0.93) points, (2.57 ± 0.74) points and (1.12 ± 0.43) points respectively. The pain scores of VAS in both groups were significantly better than those before analgesia (P <0.05). There was no significant difference in VAS pain scores between the two groups at different time points after analgesia (P> 0.05). The duration of first and second stage of labor and the duration of contractions in group A were (413.25 ± 50.82) min and (52.66 ± 15.90) min, respectively, (0.37 ± 0.12) min in group A; The duration of first and second stage of labor and the duration of uterine contractions were no significant difference between the two groups (P> 0.05), the time was (406.89 ± 49.98) min, (50.81 ± 15.73) min and (0.34 ± 0.11) . There was no significant difference in Brogar score of maternal improvement after delivery between two groups and Apgar score at 5 min after delivery (P> 0.05). There was no significant difference between the two groups (P> 0.05) in the indices of blood gas analysis of umbilical artery and umbilical vein after the delivery of fetus, there was significant difference between the two groups (P <0.05), but both were within the normal range. CONCLUSION: Both bupivacaine and ropivacaine can be effectively used for epidural analgesia and have no significant effect on neonatal umbilical blood gas analysis indexes.