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目的探讨罗哌卡因复合芬太尼在无痛分娩中对母婴的影响。方法 172例初产妇,随机分为单药组和联合组,每组86例。单药组单纯硬膜外注入盐酸罗哌卡因;联合组硬膜外注入盐酸罗哌卡因+芬太尼混合液。比较两组产妇镇痛期间血压、心率变化和新生儿Apgar评分差异,同时比较两组产妇第一、二产程及阴道顺产、剖宫产情况。结果两组产妇镇痛前、镇痛30、60 min时血压、心率比较差异均无统计学意义(P>0.05)。两组新生儿1、5、10 min Apgar评分比较差异均无统计学意义(P>0.05)。两组镇痛前、分娩后视觉模拟评分(VAS)比较差异均无统计学意义(P>0.05)。镇痛30 min时联合组视觉模拟评分(VAS)明显低于单药组(P<0.05)。联合组的第一产程明显低于单药组,阴道顺产明显高于单药组,剖宫产明显低于单药组,差异均有统计学意义(P<0.05)。结论罗哌卡因联合芬太尼应用于无痛分娩可有效减少产妇剖宫产的风险,提高阴道顺产率,且不会对新生儿、产妇机体产生明显的影响,值得临床推广应用。
Objective To investigate the effect of ropivacaine combined with fentanyl on mothers and babies during painless childbirth. Methods 172 cases of primipara, were randomly divided into single drug group and combined group, 86 cases in each group. Single-drug group was injected epidural ropivacaine hydrochloride alone; the combination group was injected epidural ropivacaine hydrochloride and fentanyl mixture. The changes of blood pressure, heart rate and neonatal Apgar score were compared between two groups during maternal analgesia. The first and second stage of labor and vaginal birth and cesarean section were compared between the two groups. Results There was no significant difference in blood pressure and heart rate between the two groups before analgesia at 30 and 60 minutes (P> 0.05). There was no significant difference in Apgar score between the two groups at 1, 5 and 10 min (P> 0.05). There was no significant difference in visual analogue scale (VAS) between the two groups before and after labor analgesia (P> 0.05). Visual analgesia score (VAS) in the combined group at 30 min was significantly lower than that in the single drug group (P <0.05). The first stage of labor in the combination group was significantly lower than that in the single drug group. The vaginal delivery was significantly higher than that in the single drug group and the cesarean section was significantly lower than the single drug group (P <0.05). Conclusion The application of ropivacaine combined with fentanyl in painless childbirth can effectively reduce the risk of cesarean section and improve the vaginal delivery rate without affecting the neonates and maternal bodies. It is worthy of clinical application.