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目的:通过测定脐血中α1-酸性糖蛋白(alpha-1-acid glycoprotein,AAG)浓度,来比较罗哌卡因和布比卡因分娩镇痛中对胎儿的毒性作用。方法:选择42例产前检查估计能从阴道自然分娩的头位、单胎足月初产妇。随机分为三组,A组为罗哌卡因-芬太尼组;B组为布比卡因-芬太尼组;C组为未行分娩镇痛对照组,每组各14例。分娩镇痛采用病人自控硬膜外镇痛(patient-controlledepidural analgesia,PCEA),PCEA剂量为基础注药速率为6m l/h,冲击量均为2m l,锁定时间均为10m in。采用“速率散射比浊法”测定脐血中α1-酸性糖蛋白浓度,进行脐血血气分析,进行胎儿的Apgar评分和SpO2检测,视觉模拟镇痛评分法(VAS)评定产妇疼痛程度,用下肢运动神经阻滞评分法(MBS)评定产妇运动神经阻滞程度。结果:两组产妇的镇痛效果无显著差异。罗哌卡因组脐血α1-酸性糖蛋白浓度和pH值明显高于布比卡因组(P<0.05)。罗哌卡因组1分钟胎儿Apgar评分和胎儿血氧饱和度明显高于布比卡因组(P<0.05)。布比卡因组对运动神经阻滞大于罗哌卡因组。结论:在分娩镇痛时,罗哌卡因对胎儿毒性低于布比卡因。
OBJECTIVE: To compare the toxic effects of ropivacaine and bupivacaine on labor analgesia by measuring the concentration of alpha1-acid glycoprotein (AAG) in umbilical cord blood. METHODS: Forty-two prenatal tests were performed to estimate the head position of spontaneous vaginal delivery and single-term full term primipara. Group A was treated with ropivacaine-fentanyl; group B was treated with bupivacaine-fentanyl; group C was untreated labor-control analgesia, with 14 patients in each group. Labor analgesia was controlled by patient-controlled epidural analgesia (PCEA). The injection rate of PCEA was 6ml / h, the impact volume was 2ml, and the locking time was 10mm. The concentration of α1-acid glycoprotein in umbilical cord blood was measured by “rate nephelometry”, and blood gas analysis of cord blood was performed. The Apgar score and SpO2 of the fetus were measured. Visual acuity analgesia score (VAS) was used to assess the degree of maternal pain. Motor neurological block score (MBS) was used to assess the degree of maternal motor block. Results: The two groups of maternal analgesic effect no significant difference. The concentration and pH value of α1-acid glycoprotein in cord blood in ropivacaine group was significantly higher than that in bupivacaine group (P <0.05). Apard score and fetal oxygen saturation in 1-minute ropivacaine group were significantly higher than those in bupivacaine group (P <0.05). Bupivacaine group had more motor nerve block than ropivacaine group. Conclusions: Ropivacaine is less toxic to fetuses than bupivacaine during labor analgesia.