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目的:研究单纯应用不同浓度的甲磺酸罗哌卡因以PCEA(自控泵硬膜外镇痛)的方式实施无痛分娩的效果、安全性及对母婴和产程的影响。方法:将要求阴道分娩者90例随机分为3组,予连续硬膜外麻醉,先予1.5%的利多卡因3 ml实验剂量观察起效并无局麻药中毒及脊麻征象,连接自控泵均采取LCP模式,I组应用0.15%甲磺酸罗哌卡因100 ml,II组应用0.25%甲磺酸罗哌卡因100 ml,III组应用0.35%甲磺酸罗哌卡因100 ml。观察3组产妇的镇痛程度(采用VAS评分法)、产后产妇的满意度、产妇生命体征变化、产程、宫缩及胎心情况、新生儿评分、剖宫产率、产钳助产率,产后观察有无尿潴留、恶心、呕吐、呼吸抑制等不良反应,分娩结束后,查阅计算机微泵记录,统计药物总用量和PCA剂量及次数。结果:使用0.15%罗哌卡因的分娩镇痛效果差,产妇满意度低;使用0.35%罗哌卡因的分娩镇痛效果好,但是产钳助产率较高;使用0.25%罗哌卡因的分娩镇痛效果好,产钳助产率较低,产妇满意度高。其他指标:①3组产妇分娩前后的血压、心率、SpO2均无明显变化;②3组新生儿Apgar1 min和5 min评分没有明显差异;③麻醉混合液总用量3组间比较无明显差异,PCA按压次数Ⅰ组明显多于Ⅱ、Ⅲ组(P<0.01),但实际有效次数和PCA总量无明显差异;④3组产妇产程中均使用催产素增强宫缩,剂量、浓度以及用药时间无明显差异,Ⅰ组有1例恶心呕吐、1例尿潴留;Ⅱ组有1例尿潴留;Ⅲ组有2例恶心呕吐,组间比较无统计学差异,未见其它并发症和不良反应。结论:单纯使用0.25%的罗哌卡因用于连续硬膜外自控泵分娩镇痛,是安全而有效的,用药单一,便于观察,节约用药成本,值得推广。
OBJECTIVE: To study the effects, safety and effects on maternal, infant and labor induced by painless childbirth induced by different concentrations of ropivacaine mesylate alone in a PCEA (self controlled pump epidural analgesia). Methods: Ninety vaginal delivery patients were randomly divided into three groups. The patients were given continuous epidural anesthesia, first with 1.5% lidocaine 3 ml, and without any local anesthetic poisoning and spinal cord signs. The connection of self-controlled pump LCP mode was adopted. Group I received 100% ropivacaine mesylate 0.15%, group II 0.25% ropivacaine mesylate 100 ml, and group III 0.35% ropivacaine mesylate 100 ml. The degree of analgesia (using VAS score method), postpartum maternal satisfaction, changes in maternal vital signs, labor, contractions and fetal heart rate, neonatal score, cesarean section rate, forceps delivery rate, postpartum Observed with or without urinary retention, nausea, vomiting, respiratory depression and other adverse reactions, after delivery, access to computerized micropump records, total drug dose and PCA dose and frequency. RESULTS: Labor analgesia with 0.15% ropivacaine was poor and maternal satisfaction was low; labor analgesia with 0.35% ropivacaine was good, but barnacle delivery was high; and ropivacaine 0.25% The analgesic effect of labor is good, the forceps delivery rate is low, and the maternal satisfaction is high. Other indicators: ①3 group before and after delivery of blood pressure, heart rate, SpO2 were no significant changes; ② neonatal Apgar1 min and 3 min neonatal 3 min score was no significant difference; ③ the total amount of anesthesia mixture was no significant difference between the three groups, PCA compression Group Ⅰ was significantly more than group Ⅱ and Ⅲ (P <0.01), but the actual number of times and PCA had no significant difference; ④ In group 3, oxytocin was used to enhance uterine contractions, and there was no significant difference in dosage, There was 1 case of nausea and vomiting in group Ⅰ, 1 case of urinary retention, 1 case of urinary retention in group Ⅱ, and 2 cases of nausea and vomiting in group Ⅲ. There was no significant difference between the two groups. No other complications and adverse reactions were found. Conclusion: It is safe and effective to use 0.25% ropivacaine alone for continuous epidural pump labor analgesia. It is safe and effective to use single dose of ropivacaine for observation and cost saving. It is worth popularizing.